delivering evidence based heart failure care jane dudley heart failure specialist nurse
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Delivering Evidence Based Heart Failure Care
Jane Dudley
Heart Failure Specialist Nurse
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Learning Outcomes Define the term heart failure. understand the role of the specialist nurse
in caring for patients with this long term condition.
Have a basic understanding of medical and non medical management.
Have an understanding of worsening symptoms and report any change in symptoms to appropriate healthcare professional eg, HF Specialist Nurse, District Nurse, Community Matron.
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■ In the UK there are about 63,000 new cases of heart failure each year
■ Currently about 878,000 people in UK have definite or probable heart failure
Heart failure has a poor prognosis - 40% of people diagnosed with heart failure die within a year.
■ Survival rates similar to those from cancer of the colon, worse than those from cancer of the breast, uterus, bladder and prostate.
Impact of Heart Failure
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■ It is estimated that over 5% of all deaths in the UK are due to heart failure.
■ People with heart failure have a lower quality of life than people with arthritis, chronic lung disease or angina.
■ In England 2% of all inpatient bed days are due to heart failure. This is projected to increase by 50% over the next 25 years.
■ Annual cost of heart failure to the National Health Service in the UK is about £625 millionBritish Heart Foundation 2008
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NYHA CLASSES NYHA I: Asymptomatic
No limitation
NYHA II: Mild
Slight limitation in physical activity
Comfortable at rest, slightly SOBOE
NYHA III: Moderate
Marked limitation of physical activity
NYHA IV:Severe
Unable to carry out physical activity without
symptoms . Symptoms of breathlessness at
rest
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Morbidity and mortality for all grades of
symptomatic chronic heart failure are high.
20-30% 1 year mortality in mild to moderate
heart failure ( class 11 – 111 )
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50% + 1 year mortality in severe heart failure ( class 1V )
Overall survival at 8 years for all classes is approx 30%
Gibbs, Davies & Lip 2000
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The NSF Goal
Every primary care team should ensure that all
those with heart failure are receiving a full package
of appropriate investigation and treatment,
demonstrated by clinical audit data not more than
12 months old
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Available at www.nice.org.uk
NICE Heart Failure Guideline, July 2003
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The Health Service Cost of Heart Failure
Drugs9%
Outpatient investigations6%
Primary Care17% Inpatient care
60%
OPD care8%
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Aims Bridge the gap between primary and
secondary care Patient and carer focused To optimise the management and improve the
quality of life experienced Prevent unnecessary hospitalisations Patient journey as smooth as possible and not
fragmented Proactive intervention rather than reactive
response.
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Referral Criteria - Who is seen?
Patients with echocardiography / angiography evidence of LVSD who
are:
Experiencing decompensating heart failure at home or in hospital.
Failing to comply with therapy.
Not on optimal treatment regimes
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Exclusion Criteria
Unwilling to have support.
Other immediate life threatening illness.
History of abusive behaviour towards health care professionals.
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Patient referred to HFS
Visit 1Full clinical and social assessment
Information on diagnosisContact details of HFS given
Management Plan FormulatedNext visit arranged
Visit 2Monitoring of clinical condition
Review of medication regime/complianceDiscussion of self management issues
Risk factor modificationRisk stratification
Low Dependency
High DependencyMedium Dependency
Review3-6 months/Open Appt
Review 1-12 weeks
Review 1-6 weeks
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Patient Education
Heart failure and its management Medication Daily weight monitoring Early symptom recognition Importance of diet/fluid restriction Lifestyle changes Need for immunisation
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HEART FAILURE NURSE
PROMOTE COMPLIANCEEDUCATE PATIENT
AND FAMILY
IMPLEMENT TREATMENT ALGORITHMS
MONITOR PATIENT
REDUCE RE-ADMISSIONS
REDUCE COST
IMPROVE QUALITYOF LIFE
REDUCE MORTALITY
(Gibbs, Davies and Lip 2000)
Role of the HFN
Aim
Role of Heart Failure NurseRole of Heart Failure Nurse
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General Advice Immunisations
Annual influenza Single pneumoccocal
Sufficient medication for holidays Palliative care support throughout
the course of the disease Management of gout, anxiety, pain, nausea
and fatigue
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Benefits to the Health Community
standards of care for heart failure patient enhanced
improved liaison between Primary and Secondary Care
provides a resource for health care professionals
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Impact Of Heart Failure Services
Supported by BHF, funded by Big Lottery Fund (2004). 76 HFSN’s were employed by PCTs in England. (University of York Research)
Main Findings Average reduction in HF admissions
43% Average reduction in all cause
admissions 35% Average Length of stay 11.6 nights.
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Main Findings Average proportion of patients in
the PCT discharged with coding of HF seen by HFSN’s 34%.
Average estimated saving per patient £1,826
Estimated saving to the PCT if nurse sees 100 pts per year over and above cost of salary £182,600.
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Effective local services which are Effective local services which are responsive to patients needs can make responsive to patients needs can make a very significant difference to the way a very significant difference to the way that people experience this condition, that people experience this condition, slowing the progress of heart failure and slowing the progress of heart failure and providing sensitive and supportive care providing sensitive and supportive care for people who are dyingfor people who are dying..
Developing Services for Heart FailureDeveloping Services for Heart FailureDepartment of Health 2003Department of Health 2003
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CONTACT DETAILS British Heart Foundation Heart Failure Specialist Nurse’s
Jane Dudley 07766656598 Newark and Sherwood Ann Wilson 07766656683 Mansfield