Specialist Heart Failure Nurses Research Articles

HeartFailure Specialist Care and Long-Term Outcomes for Patients Admitted With Acute HeartFailure.

For patients with acute heart failure (HF), specialist HF care during admission improves diagnosis and treatments. The authors aimed to investigate the association of HF specialist care with in-hospital and longer term prognosis. The authors used data from the National HeartFailure Audit from January 1, 2018, to December 31, 2022, linked to electronic records for hospitalization and deaths. All-cause mortality was the primary outcome measure and in-hospital mortality the secondary outcome measure. Data for 227,170 patients admitted to hospital with HF (median age: 81 years; IQR: 72-88 years), were analyzed. Approximately 80% of acute HF admissions received support from HF specialists. Thirty-nine percent of patients (n=70,720) were seen by a multidisciplinary team (HF physicians and HF specialist nurses [HFSNd]), 22% (n=40,330) were seen by HFSNs alone, and the remaining 39% (n=71,700) were seen exclusively by specialist HF physicians. At discharge, more patients who received HF specialist care were prescribed medical therapy for HF and had specialized follow-up. Conversely, diuretic agents were prescribed to fewer patients. HF specialist care was independently associated with a higher rate of prescribing HF therapies at discharge and a lower likelihood of receiving diuretic therapy (OR: 0.90 [95%CI: 0.86-0.95]; P< 0.001). HF specialist care was associated with better long-term survival (HR: 0.89 [95%CI: 0.87-0.90]; P< 0.001) and lower in-hospital mortality (OR: 0.92 [95%CI: 0.0.88-0.97]; P<0.001). Receiving HF specialist care during admission for HF is associated with a higher rate of implementation of medical therapy, fewer discharges on diuretic therapy, and lower in-hospital and long-term mortality across the left ventricular ejection fraction spectrum, especially for patients with heart failure with reduced ejection fraction.

A virtual heart failure ward in a rural demography

Abstract Background Lincolnshire is a large rural county in the UK with wide economic variation, social deprivation, poor communication infrastructure and no large urban centre of population. As a result of these factors we have a significant incidence of heart failure and a variation in access to services. As part of a county wide initiative to improve the care of patients with heart failure and to reduce acute reduce admissions to hospital we introduced a virtual heart failure ward in January 2022. The ward is overseen by the community cardiology heart failure specialist nurses and led by a cardiology Advanced Clinical Practitioner (ACP) - a multi-professional worker educated to Level 7 with the ability to prescribe and request procedures/ investigations. Governance is from the acute cardiology team via multi-disciplinary meetings. Patients who are decompensating that historically would have required admission can be 'admitted' to the ward and patients who have been admitted to the acute hospital can also be admitted/ stepped down to facilitate discharge. The ward is supported by a 7/7 (expanded from 5/7 to support the project) specialist nursing team, weekly ward rounds, telemedicine (multi-provider app), remote monitoring (oximetry/ weight/ BP), outpatient IV furosemide, specialist heart failure rehabilitation (F2F and remote) and supports a seamless service between primary, community and secondary care. Results In the first 13-months N=213 patients were treated via the virtual ward. N=137 (64%) 'step up, N=75 (35%) step down, N=1 (self-referral), see figure one. N=194 patients were discharged. N=25 (12%) were admitted for escalation of care, see figure two. In the first year, we estimate that the virtual ward released 1,147 acute bed days (1,033 admission prevention and 114 early discharge) and delivered a cost reduction of approximately to £1m. An external audit team has identified a 10% reduction in heart failure admissions to the acute hospital. PROMS (patient recorded outcome measures) show high patient satisfaction and staff have found the enhanced 7/7 service beneficial and rewarding. Discussion Our experience of implementing a virtual heart failure ward in a rural demography has been exceedingly positive. We have observed significant reductions in admissions, facilitated early discharged from hospital with high patient and staff satisfaction. this intervention has also delivered a substantial cost saving to the wider health economy.Step Up/ Step DownDischarge Destinations

Smartphone-Based Remote Monitoring for Chronic Heart Failure: Mixed Methods Analysis of User Experience From Patient and Nurse Perspectives.

Community-based management by heart failure specialist nurses (HFSNs) is key to improving self-care in heart failure with reduced ejection fraction. Remote monitoring (RM) can aid nurse-led management, but in the literature, user feedback evaluation is skewed in favor of the patient rather than nursing user experience. Furthermore, the ways in which different groups use the same RM platform at the same time are rarely directly compared in the literature. We present a balanced semantic analysis of user feedback from patient and nurse perspectives of Luscii, a smartphone-based RM strategy combining self-measurement of vital signs, instant messaging, and e-learning. This study aims to (1) evaluate how patients and nurses use this type of RM (usage type), (2) evaluate patients' and nurses' user feedback on this type of RM (user experience), and (3) directly compare the usage type and user experience of patients and nurses using the same type of RM platform at the same time. We performed a retrospective usage type and user experience evaluation of the RM platform from the perspective of both patients with heart failure with reduced ejection fraction and the HFSNs using the platform to manage them. We conducted semantic analysis of written patient feedback provided via the platform and a focus group of 6 HFSNs. Additionally, as an indirect measure of tablet adherence, self-measured vital signs (blood pressure, heart rate, and body mass) were extracted from the RM platform at onboarding and 3 months later. Paired 2-tailed t tests were used to evaluate differences between mean scores across the 2 timepoints. A total of 79 patients (mean age 62 years; 35%, 28/79 female) were included. Semantic analysis of usage type revealed extensive, bidirectional information exchange between patients and HFSNs using the platform. Semantic analysis of user experience demonstrates a range of positive and negative perspectives. Positive impacts included increased patient engagement, convenience for both user groups, and continuity of care. Negative impacts included information overload for patients and increased workload for nurses. After the patients used the platform for 3 months, they showed significant reductions in heart rate (P=.004) and blood pressure (P=.008) but not body mass (P=.97) compared with onboarding. Smartphone-based RM with messaging and e-learning facilitates bilateral information sharing between patients and nurses on a range of topics. Patient and nurse user experience is largely positive and symmetrical, but there are possible negative impacts on patient attention and nurse workload. We recommend RM providers involve patient and nurse users in platform development, including recognition of RM usage in nursing job plans.

Report from the Northern Ireland Heart Failure Nurse Forum's educational meeting

This year, the Northern Ireland Heart Failure Nurse Forum relaunched with the aim of supporting, developing and promoting the essential role of heart failure specialist nurses in Northern Ireland. One of their first priorities was to host an educational meeting for their members, colleagues working in cardiac rehabilitation and cardiology nurses. This report summarises the content of the day, highlighting some topical issues in 2022.

HFRenDs: an inaugural conference of heart failure, renal and diabetes specialist nurses

Journal of Kidney CareVol. 7, No. 6 Association of Nephrology NurseshFRenDs: an inaugural conference of heart failure, renal and diabetes specialist nursesMarissa DaintonMarissa DaintonEmail: E-mail Address: [email protected]Education Committee Member, Association of Nephrology Nurses UKSearch for more papers by this authorMarissa DaintonPublished Online:22 Nov 2022https://doi.org/10.12968/jokc.2022.7.6.298AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Jankowski J, Floege J, Fliser D, Böhm M, Marx N. Cardiovascular disease in chronic kidney disease. Circulation. 2021; 143(11):1157–1172. https://doi.org/10.1161/circulationaha.120.050686 Google ScholarUK Renal Registry. 24th Annual report. 2022. https://ukkidney.org/audit-research/annual-report/24th-annual-report-data-31122020 (accessed 4 October 2022) Google Scholar FiguresReferencesRelatedDetails 2 November 2022Volume 7Issue 6ISSN (print): 2397-9534ISSN (online): 2397-9542 Metrics History Published online 22 November 2022 Published in print 2 November 2022 Information© MA Healthcare LimitedKeywordsheart failurerenaldiabetesspecialist nursesPDF download

How do Heart Failure Caregivers gain information and support for their role? The contribution of specialist nurses.

Abstract Funding Acknowledgements Type of funding sources: None. Background Current evidence shows caregivers of people with Heart Failure are susceptible to a deterioration of their own health as a consequence of carrying a high degree of burden as a result of this role (McIlfatrick et al 2018, McHorney et al 2021). This level of burden appears to be a consequence of a limited understanding of heart failure symptoms and complex medication management, further perpetuated by being unsure of where to ask for help (Boyd et al 2004, Exley et al 2005). The empirical evidence further suggests caregivers of people with Heart Failure experience a reduced quality of life, lack understanding of the Heart Failure trajectory (Etemadifar et al 2015, Fitzsimmons et al 2019), do not have adequate support networks (Shahrbabaki et al 2016) and require help and guidance with the care needs of the person with Heart Failure (Tavakoli et al 2018, Hayashi et al 2021). Purpose The aim of this study was to explore the support and information needs of caregivers of people with Heart Failure, in particular to explore the support provided by specialist Heart Failure Nurses. Methods A qualitative interview study was designed following the approach detailed by Brinkmann and Kvale (2015). A thematic analysis of the transcripts was conducted using the Braun and Clark’s Thematic Analysis approach (Braun and Clarke 2012). Coding of the interview transcripts was undertaken by two researchers (HW and SS), agreement reached and subsequent discussion and refinement by the Public/Patient Involvement (PPI) group of two heart failure nurse specialists and an ex-caregiver. Results Thematic analysis identified 4 themes: Taking on the role of caregiver; Getting to grips with being a caregiver; Impact on own health and wellbeing; Need for information and Support. This presentation will focus on the data that was a thread through each of the themes relating to the role of the Heart Failure Specialist Nurse in providing information and support. Whilst the specialist nurse was universally seen as informative and someone who actually valued caregiver input, consultants and general practitioners lacked consistency and failed to include the caregiver. Conclusions Caregivers in this study felt they were lacking information and knowledge about Heart Failure and consequently felt ill-equipped to deliver and manage care. Needs identified within our study reflect earlier work demonstrating the key role played by specialist nurses in supporting and informing caregivers of people with Heart Failure.

Abstract 14004: Long Term Outcomes of Ambulatory Outpatient Management of Acute Decompensated Heart Failure in a Heart Failure Specialist Nurse Delivered Consultant Led Unit versus Inpatient Management

Introduction: Acutely decompensated heart failure (ADHF) usually results in hospitalisation for intravenous diuretics. The safety and efficacy of ambulatory or outpatient management of ADHF by heart failure specialist nurses has not been described before. Methods: This retrospective analysis compared 2 cohorts of consecutive ADHF patients - hospitalised in-patients (IP) versus outpatients (OP) who were treated with bolus intravenous diuretics in a specialist heart failure nurse delivered consultant led OP HF unit (Ambulatory HF Unit -AHFU) with input from various specialties (renal, diabetes, elderly care, chest, pharmacy, palliative, ascitic, pleural teams) from 2016 to 2020. Mean follow-up duration was similar for both groups (IP=46±8.1 months; OP=45.5± 7 months, p=0.1). We compared clinical risk scores using the Get With the Guidelines (GWTG) score, comorbidities using the Charlson Comorbidity Index (CCI) and frailty using the Rockwood Clinical Frailty Index (CFI). Results were expressed as mean±SD, analysed using the Student’s T test and Chi-squared test. Results: 1012 patients were treated in our specialist outpatient AHFU and 1889 patients were hospitalised. Mean number of visits per ambulatory spell was 5.1±-2.2 days and the median dose of furosemide was 220 mg (range 80-480). Average hospital stay for IP was 12.1±5 days. CCI (IP=6.5±2; OP=6.4±1.9; p=0.19) and mean GWTG scores were similar (IP=40.4±7.9; OP=39.9±7.1; p=0.09) between the 2 groups but mean Frailty Index was higher amongst the IP group (IP 5.1±1.2; OP 4.9±1; p=0&lt;0.001). 30 day hospitalisation and mortality (30 day,1 year and overall mortality) were lower in the OP cohorts. Conclusions: Ambulatory management of ADHF using bolus IV diuretics in a heart failure specialist nurse delivered consultant led multidisciplinary unit offers an effective alternative to hospitalisation and also leads to improved outcomes. Frailty Index can help assess suitability for outpatient management of ADHF.

One year outcomes of heart failure multispecialty multidisciplinary team virtual meetings

Abstract Heart Failure is frequently associated with several comorbidities such as ischaemic heard disease, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease and frailty. This level of complexity is best dealt with by a multispecialty multidisciplinary team (MDT) model. This was a single centre observational study (January 2020-December 2020) that was undertaken in a British university hospital looking at effect of HF multispecialty virtual MDT meetings on HF outcomes. Patients acted as their own controls outcomes compared for equal period pre versus post MDT meeting. The multi-specialty meeting was conducted once monthly via video-conferencing. It consisted of heart failure cardiologists (from primary secondary and tertiary care), heart failure specialist nurses (hospital and community), nephrologist, endocrinologist, palliative care specialists, chest physician, pharmacist, pharmacologist and geriatrician. Recommendations were made as consensus from the multispecialty meeting. The main outcome measures were 1) number of hospitalisations and 2) outpatient clinic attendances 3) cost savings. A total of 189 patients were discussed from January-December 2020. This was uninterrupted during the COVID-19 pandemic. The mean age was 70.3±18.1 years and median follow-up 6 months (range 1–13 months). The mean Charlson Co-morbidity score was 5.3±1.2 and Rockwood Frailty Score was 4.9±1. The mean number of outpatient clinic attendances avoided was 1.7±0.4. This reduced inconvenience to patients, saved patients money (transport and parking costs) and led to carbon footprint reduction. The MDT meeting total costs were £15,400 and the 31 clinic appointments they generated cost an estimated £3720. However, the MDT meetings prevented 277 clinic appointments (cost saving £33,352). Finally, the mean number of hospitalisations pre-MDT was 0.7 Vs 0.2 post MDT (p&amp;lt;0.01) with a saving of around 730 bed days (estimated cost-saving £260,000). The HF multispecialty virtual MDT approach provides seamless integration of primary care community services with secondary and tertiary care. Consensus decision from MDT meetings provides holistic approach for HF patients with comorbidities and frailty, and reduces inconvenience to patients by preventing the need to attend multiple specialty clinics. This approach can also lead to significant cost-savings to the healthcare system. Funding Acknowledgement Type of funding sources: None.

Surgical Management of Heart Failure.

Optimal management of heart failure is collaborative, with the involvement of specialist heart failure physicians, nurses, interventionalists, and surgeons. In addition to medical optimisation and cardiac resynchronisation therapy, surgery plays a valuable role in many patients. We herein study the evidence and the role of surgical intervention in functional mitral regurgitation, coronary revascularisation in ischaemic cardiomyopathy, and surgical ventricular reconstruction. Additionally, we describe techniques of temporary and durable mechanical circulatory support, with their relative advantages and disadvantages, and applications. Finally, we describe the history and nomenclature around heart transplants, their indications, techniques, present-day outcomes, complications, and new developments in the field.

MO191MANAGEMENT OF HYPERKALAEMIA TO FACILITATE RAASI THERAPY IN PATIENTS WITH HEART FAILURE IN A BESPOKE UK CLINIC

Abstract Background and Aims Best practice for treatment of patients with chronic heart failure involves beta-blockers and renin-angiotensin-aldosterone system inhibitors (RAASi) such as ACE inhibitors (ACE-i), angiotensin receptor blockers (ARB), mineralocorticoid antagonists (MRA) and neprolysin inhibitor/ARB. However, use of these agents, and optimisation of their dosage, is frequently limited by hyperkalaemia, the incidence of which is increased by the co-prevalence of chronic kidney disease (CKD). Management of patients in a bespoke Hyperkalaemia Clinic can be advantageous in facilitating optimal use of RAASi. Method A Hyperkalaemia Clinic was opened in July 2019 in this tertiary renal centre within an NHS trust that hosts 4 district hospital heart failure services. Referrals of patients with left ventricular systolic dysfunction whose RAASi could not be optimised because of hyperkalaemia were encouraged from heart failure specialist nurses and cardiologists. Management of the patients incorporated commencement of patiromer at 8.4g daily and increases in RAASi was usually devolved to the referring team. This report describes the activity and short-term outcomes of the first 17 months after opening of the clinic (follow up until 1st January 2021). Results 34 patients with systolic heart failure and problems with RAASi-associated hyperkalaemia were referred to the clinic. Mean age was 74 (range 44-88) years, 28% had stage 3a, 28% 3b and 8% stage 4 CKD. ACE-I or ARB were being used in 73% of patients at referral, 73% were using beta blockers and 50% MRA with loop diuretic use in 70%. At first visit 64% had normokalaemia, and 36% serum potassium 5.4-6.0 mmol/L. During follow-up, 6 (18%) patients discontinued patiromer due to gastrointestinal side effects, 3 no longer required the binder because of decrease in RAASi use and 2 patients died (one each from stroke and sepsis). One patient was switched to an alternative potassium binder. As of 1st January 2021, patiromer was still being administered to 22 (65%) patients, 8 of which had received this for &amp;gt;12 months; all patients remained normokalaemic and none of them required magnesium supplementation. An increase in RAASi therapy had occurred in only 12 (35%) patients. Conclusion Our experience demonstrates the relative simplicity of managing hyperkalaemia via a bespoke clinic in cardio-renal patients. As this was nephrology-led, optimised management was dependent upon the assertive and collaborative involvement of the referring heart failure teams who helped with biochemical monitoring and alteration of RAASi therapy. However, less than half of the patients benefitted from an increase in RAASi therapy after normalisation of serum potassium, and there was definitely scope for improving this component of the care pathway via more direct multi-disciplinary interaction with the heart failure teams.

Abstract 15659: Dynamic Device Derived Heart Failure Risk Score as a Predictor of Heart Failure Hospitalisation

Introduction: The number of people being admitted to hospital in England due to heart failure (HF) has risen by a third in the last five years. Implantable cardiac devices with integrated heart failure diagnostics are capable of combining daily measurements of multiple device-derived parameters and provide a heart failure risk score (HFRS) which might help predict HF worsening. Methods: Between 2015 and 2019 231 consecutive HF device patients were co-managed (CM) by specialist HF nurses in a tertiary centre. Follow-up was truncated at last device transmission in 2019. HF nurses’ interventions to alerts were recorded prospectively. HF-related hospitalisations were collected from hospital records. We analysed the predictive value of baseline variables on the count of days in high HFRS in a negative binomial regression model. The device settings: Optivol CareAlert switched ON vs OFF were compared. Results: 200 patients with CRT-D were followed up for 2.6 [1.0-2.8] years (Figure). Baseline characteristics and their effect on the incidence rate ratio (IRR) of days in high HFRS are presented in Table. A total of 3,486 transmissions were assessed, median 7.3 [5.9-10.0] per patient-year; 591 high HFRS episodes occurred in 115 (58%) pts. Optivol OFF increased the rate of high HFRS being transmitted &gt;30 days after its end (45% vs 35%, P=0.018) and increased the time from episode start to transmission (36 [16-68] vs 24 [8-53] days, P&lt;0.001). Of 21 hospitalisations for decompensated HF, 15 were predicted by high HFRS within 30 days whereas 6 were predated by medium HFRS. Conclusion: Patients who have not had a single high HFRS during follow-up did not need admission for decompensated HF.

Variable structure and provision of guideline-based care in specialist heart failure centres in the UK: a survey of 100 health professionals

Background/aimsChronic heart failure is a common condition with a poor prognosis, and its prevalence is increasing in the UK and elsewhere. Patients with heart failure require complex multidisciplinary care, with appropriate medicines optimisation, nursing support and management of comorbidities, ideally delivered via a multidisciplinary team integrated between the community and the hospital. This study aimed to investigate how heart failure care services are structured and delivered.MethodsA survey of 100 health professionals in 79 heart failure centres was conducted by post or telephone using the same structured question format.ResultsThere was widespread variability in the provision of key elements of heart failure nursing (specialist heart failure nurses, nurse prescriber, nurse consultant). A total of 15% of trusts had no local consultant with special interest in heart failure; 73% had no pharmacist; and 83% had no mental health specialist working in the heart failure healthcare team. Dedicated administrative support was absent in 24% of trusts. One-fifth (20%) did not offer exercise rehabilitation. A total of 68% reported insufficient resources available locally for individualised exercise rehabilitation, in accordance with guidelines from the National Institute for Health and Care Excellence.ConclusionsThe structure and provision of heart failure care is variable across the UK, and not always consistent with current guidelines. Reducing this variability across the UK is an urgent priority and will require increased resources, especially for specialist nurses embedded within the routine care of patients with chronic heart failure.

The role of the heart failure nurse and use of sodium glucose cotransporter-2 inhibitors

Diabetes significantly increases the morbidity and mortality faced by patients with heart failure. Sodium glucose cotransporter-2 inhibitors can improve glycaemic control and reduce mortality. They can also improve the cardiovascular risk profile as well as act as a diuretic and reduce hospital admissions because of heart failure. This article will review how these medications work, their place in the treatment of heart failure and the patient education needed before starting these medications. The article will also discuss the role played by heart failure specialist nurses in prescribing and monitoring the impact of these medications on patients. The article concludes with a horizon scan of the potential future implications of these medications for heart failure specialist nurses

Increasing the heart failure nursing workforce: recommendations by the British Society for Heart Failure Nurse Forum

There are almost 1 million people diagnosed with heart failure in the UK, and this number continues to rise. It is a common cause of hospitalisation and costs associated with those hospitalisations account for a significant proportion of the NHS budget. Studies have demonstrated that community heart failure specialist nurses improve patient outcomes and reduce the costs associated with hospitalisation. Yet, despite increased prevalence, considerable advances in therapies, and new recommendations from the National Institute for Health and Care Excellence, the recommended number of heart failure specialist nurses per 100 000 has stayed the same. This article will describe the development of community heart failure nursing in the UK, and outline the challenges currently facing heart failure specialist nurses. It makes a number of recommendations that would ensure heart failure patients are able to be seen by a heart failure specialist nurse in a timely manner, help reduce inequalities of care, reduce costs associated with heart failure hospitalisations and help ensure sustainability of heart failure services over the longer term.

The role of the heart failure nurse and use of sodium glucose cotransporter-2 inhibitors

Diabetes significantly increases the morbidity and mortality faced by patients with heart failure. Sodium glucose cotransporter-2 inhibitors can improve glycaemic control and reduce mortality. They can also improve the cardiovascular risk profile as well as act as a diuretic and reduce hospital admissions because of heart failure. This article will review how these medications work, their place in the treatment of heart failure and the patient education needed before starting these medications. The article will also discuss the role played by heart failure specialist nurses in prescribing and monitoring the impact of these medications on patients. The article concludes with a horizon scan of the potential future implications for heart failure specialist nurses of these medications.

P2593Evaluation of an ambulatory heart failure service - a 2 years' experience

Abstract Background Heart failure accounts for 1–2% of health care expenditure in the National Health Service in the United Kingdom. Approximately 60–70% of that cost is in hospitalization for treatment. Various methods have been employed to reduce hospitalization in chronic heart failure; however effectiveness and safety of these methods have yet to be evaluated. Our ambulatory heart failure unit, run by specialist heart failure nurses, seeks to reduce admissions to hospital for heart failure by administering intravenous (I.V) diuretics in a day unit setting for ambulatory patients. Purpose We have reviewed data from December 2016 to December 2018 of patients using the ambulatory heart failure services in our hospital and evaluated its safety and effectiveness. Methods Retrospective evaluation of data collected from the ambulatory heart failure unit over a 24-month period as well as hospital data on admissions and length of stay of heart failure patients. Qualitative data was also collected from patients using the ambulatory heart failure unit. Results Since the opening of the ambulatory heart failure unit in December 2016, we have had 393 patient episodes. Referrals were largely from the community (265, 67%) however 128 (33%) patients were referred from an inpatient setting. Patients were treated for a mean of 12 days with intravenous furosemide infusion. The minimum dose of furosemide used was 120mg over 1 hour whereas maximum dose was 360mg over 2 hours. This translated into 4351 hospital bed days saved in a 24-month period. 144 (37%) of patients had heart failure with preserved ejection fraction (EF &gt;40%), and 239 (61%) had heart failure with reduced ejection fraction (EF &lt;40%). 28 patients (7%) referred to the unit were deemed inappropriate for unit and required admission. A further 35 patients (9%) were admitted to hospital for other illnesses whilst being treated on the unit due to various reasons. 3 patients (0.8%) died in the community during the period they were receiving care on the unit. Of the 63 patients (16%) admitted to hospital 23 (6%) died during that hospital admission. The number of all cause mortality of our patients was 26 (7%) during the time they were treated on the unit. Whilst the number of heart failure hospital admissions remained similar, the average length of stay in hospital for heart failure dropped by 0.99 days. Patient feedback on the unit was excellent, with patients feeling more independent and in control of their health. Conclusions The ambulatory heart failure unit reduces the burden on the hospital by reducing the length of stay of heart failure patients and may be preferred by patients. Intravenous diuretics on a day case basis are safe, as evident by unchanged overall mortality of heart failure patients.

EXAMINING THE LEARNING NEEDS OF PATIENTS WITH REDUCED EJECTION FRACTION POST MYOCARDIAL INFARCTION

Patients with a reduced left ventricular Ejection Fraction (LVEF) post Myocardial Infarction (MI) are at risk of adverse outcomes such as the development of symptomatic Heart Failure (HF) (Shah et al., 2017). Although improvement of LVEF may occur early after initial event, due to the structural damage and remodeling of the myocardium, up to 50% of patients do not demonstrate improvement in LVEF several months after their initial MI (Chew et al., 2018). These patients are predisposed to the development of HF, making it essential that they are aware of possible symptoms post discharge and understand when to notify their physician. Most patients in this ‘grey zone’ would not necessarily receive any in-hospital education related to HF as they would not meet criteria for HF Clinical Pathways or Guideline related standards as they don’t have clinical HF. A quality improvement project was initiated at our tertiary cardiac care institution to examine the learning needs of patients with a reduced LVEF post MI to improve standard education practices and improve patient outcomes. The project used a qualitative, descriptive approach in which ten patients (post MI with reduced LVEF ≤ 40%) and six healthcare professionals (HF Nurse Specialists, Cardiologist) participated in telephone or face-to-face, semi-structured interviews. Data was analyzed for key patterns and themes. Four main themes were identified in the analysis: EF Knowledge, Heart Failure Signs and Symptoms, Understanding and Teaching, and Cardiac Rehabilitation Programs. Most participants perceived there were no explicit standards on the education surrounding EF and the signs and symptoms of heart failure. Furthermore, although cardiac rehabilitation programs have become an integral part of the standard of care, poor patient adherence remains high due to a lack of understanding surrounding the benefits of this program. The complexity of cardiac patients with reduced EF post MI is a primary theme learned in that patients may oftentimes find themselves facing sudden or unexpected symptom changes after hospital discharge. Findings in this quality review have concluded that these individuals should have an understanding of individualized ejection fraction and possible HF symptoms prior to leaving hospital in order to ensure patient safety and improve clinical outcomes. Recommendations include changes to current patient education materials and classes, individualized, targeted follow up systems of care and patient-health care provider dialogue that speaks to the specific learning needs of this at-risk patient group.

Recognition and management of psychological distress in HF

Background: Evidence suggests psychological distress is common in people with heart failure (HF) and associated with adverse clinical and quality of life outcomes. Recent national guidelines highlight that there is a need to improve psychological care in HF. Purpose: This retrospective study of 11 917 clinic letters written by specialist heart failure nurses (SHFNs) contained within 2488 patient files aimed to benchmark documented recognition and management of psychological distress in HF patients by SHFNs in 11 NHS Scotland health boards. Conclusions: The study indicated SHFN case note documentation of recognition and management of psychological distress in HF fell dramatically short of clinical guidelines. Few people with HF are recognised as having associated psychological distress and fewer still are accessing evidence-based interventions. Clinical implications: Improvement to the documentation, identification and management of psychological distress in people with HF by SHFNs should be supported by training delivered by accredited psychology practitioners. There is a need for services to have clinical pathways in place to support any increases in identification of psychological distress in HF.

Self-care and improved outcomes: an intervention by heart failure nurse specialists

Background: Heart failure is a prevalent, debilitating condition. Patients need to develop and maintain effective strategies and behaviours to care for themselves and manage their illness. Aim: The aim of this study was to evaluate whether or not an educational intervention carried out by a team of heart failure nurse specialists (HFNS), as part of usual care, enhanced self-care behaviour in patients with chronic heart failure. Methods: A quantitative survey was carried out using the ‘Looking After Yourself with Heart Failure Questionnaire (LAYHFQ)’, to determine levels of self-care behaviour pre- and post-HFNS intervention. All new patients registered to a community heart failure nursing service completed the questionnaire at initial assessment and 6 weeks later, following the nurse-led intervention (N=36). Paired t-tests (2-tailed) were carried out to determine if there were significant differences between total self-care scores before and after the intervention, and for each individual self-care behaviour. Results: Selfcare was improved overall (p=0.011), with five behaviours demonstrating a statistically significant improvement: namely, the uptake of flu and pneumonia vaccination (p=0.009), regular weighing (p=0.001), recognising changes in sleep patterns (p=0.014), recognising signs of fluid retention (p=0.001), and the wellbeing dimension of going out as much as possible (p=0.019). Conclusion: An educational intervention by an HFNS leads to enhanced self-care and may result in improved physical and psychological outcomes for patients with heart failure.

Remote monitoring in heart failure.

In the developed world, there has been a substantial increase over several decades in the prevalence of congestive heart failure (CHF), partly as a result of demographic changes. Overall, 1–2% of the adult population has CHF and this increases to ≥10% in the over 70s age group.1 However, hospitalization rates due to CHF are falling,2 and length of hospital stay and in-hospital mortality have also fallen.3 It could be argued that effective outpatient management of CHF through dedicated heart failure clinics, specialist nurses, and general practitioners has played a key role in these positive trends. However, given the significant patient morbidity and the inpatient costs associated with CHF, methods to reduce hospital readmission rates are imperative to alleviate an already overstretched system. Rahimi and colleagues4 present the development and assessment of an easy-to-use, android-based monitoring system to empower patients and reduce readmission rates in a cohort from the Seamless User-centred Proactive Provision Of Risk-stratified Treatment for Heart Failure (SUPPORT-HF) study. Patients were provided with internet-enabled tablets that were connected to commercially available sensors to record blood pressure, heart rate, and weight, and provide alerts to patients to see their doctor or healthcare provider when physiological parameters were perturbed. Although this particular self-management study focused primarily on patient uptake of monitoring … [↵][1]*Corresponding author. Tel: +44 1603 592376, Fax: +44 1603 593752, Email: m.frenneaux{at}uea.ac.uk [1]: #xref-corresp-1-1