Workforce planning

We need

  • Heart failure/cardiac nursing roles to be created in primary care with clear accountability for providing patient follow up, case management1 and therapeutic education in collaboration with GPs
  • Professional societies to promote GP training on heart failure to ensure that they provide comprehensive diagnosis and follow up care to heart failure patients, particularly around the optimisation of treatment to avoid hospital re-admission
  • Heart failure specialist nurses to be officially recognised as a profession and their roles formalised through national accreditation, professional codes and specific remuneration appropriate to the professional structure of each healthcare system.

Why

  • Careful follow-up and monitoring of all patients with heart failure in community settings is critical – and many patients will be discharged from hospital before an optimal treatment is given to them.2
  • A key role for GPs is therefore to help optimise drug and device therapy for patients3 – however GPs are often under-resourced, or inadequately trained, to do so.
  • Data from several countries suggests that heart failure patients often do not receive adequate follow up from GPs in the primary care setting
    (Ireland,4 Italy5 and Belgium6)
  • Training sessions for GPs have been shown to improve GP adherence to clinical guidelines, particularly in terms of adaptations of heart failure medication in patients7
  • Multidisciplinary, nurse-led or nurse-coordinated interventions can reduce hospital admissions, improve self-care behaviour and enhance quality of life.8 In Ireland for example, specialist care and lifestyle advice from a cardiovascular nurse working alongside the GP and heart failure hospital team has been shown to help reduce hospital admissions for heart failure by as much as 45%.9

Examples of what has been done:

  • British Heart Foundation. Policy Statement - End of Life Care and Cardiovascular Disease London: British Heart Foundation 2014.

  • McMurray JJ, Adamopoulos S, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. European journal of heart failure 2012;14(8):803-69.

  • Ligue Cardiologique Belge. L'insuffisance cardiaque. Secondary L'insuffisance cardiaque 2015. http://liguecardioliga.be/maladies/linsuffisance-cardiaque/.

  • Tully N, Morgan K, McGee H, et al. Quality of Life and Quality of Care in Heart Failure: Perspectives of Irish Patients. 2009.

    Granger BB, Swedberg K, Ekman I, et al. Adherence to candesartan and placebo and outcomes in chronic heart failure in the CHARM programme: double-blind, randomised, controlled clinical trial. The Lancet 2005;366(9502).

  • Cancian Mea. The care for chronic heart failure by general practitioners. Results from a clinical audit in Italy. Eur J General Practice 2013;19:3.

  • Nellessen E. Application des trajets de soins à l'insuffisance cardiaque. Vaisseaux, Coeur, Poumons Numéro spécial 2009.

  • Strömberg A, Mårtensson J, Fridlund B, et al. Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failure. European heart journal 2003;24(11):1014-23.

  • Heart Beat Trust. Irish Heart Researchers Win International Award. In: Trust HB, ed., 2013.

  • Cowie MR, Anker SD, Cleland JG, et al. Improving care for patients with acute heart failure Before, during and after hospitalization. Heart Failure Association of the ESC 2014.

  • Ponikowski P, Anker S, AlHabib K, et al. Heart failure: preventing disease and death worldwide. : European Society of Cardiology., 2014.