- 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.
- 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 (Ireland4; Italy5 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: