Heart failure specialist nurses: managing care in the community

Heart failure is a common progressive condition which can be distressing, disabling and life-limiting. It affects an estimated 900,000 people in the UK.¹ One million inpatient bed days are attributable to heart failure in the UK each year.²

Managing heart failure is challenging as patients are often from an older age group and may require social support.

Many older people with heart failure,  also have other long-term conditions, requiring different medications. This means they may receive treatment from a number of different health professionals, which can result in fragmented care.

Heart Failure Nurse Services

Heart failure specialist nurse (HFSN) services are now well established in many areas of the UK. However, some gaps still remain in service provision and staffing levels in certain localities.

For instance, some clinical commissioning groups are decommissioning heart failure community services due to financial pressures. This could have significant health implications for the local population.

The call for change

The right pathway, appropriate treatment and support means that survival rates, experience of care and quality of life for many people living with heart failure can dramatically improve.

What we did

We tested an innovative community and home-based heart failure programme led by HFSNs. The Big Lottery Fund funded the 76 heart failure specialist nurse posts in 26 NHS primary care organisations in England.

We administered the funds, managed and supported nurses and provided professional development to help shape the roles and services.

The benefits

• From 2004-07, the 76 HFSNs saw approximately 15,000 patients; most had at least one home visit
• The programme delivered a 35% reduction in all cause admissions and significant cost savings
• An estimated £169,000 was saved per 1,000 patients as a result of access to HFSNs across the 26 sites
• An independent evaluation, demonstrated that HFSNs based in primary care, play a major role in managing and supporting heart failure patients at the critical post-diagnosis period, as well as ongoing integration in primary and secondary care.

Evidence for change

Establishing community nurse-led heart failure services and adopting a multi-disciplinary team approach can:

• Reduce hospital admissions and associated costs
• Improve quality of care, quality of life and patient experience
• Support people with heart failure to self-manage their condition
• Bridge the interface between primary, secondary and tertiary care to facilitate and improve communication channels between GPs and cardiologists. This supports the integration of patient management
• Provide HCPs with a professional contact who can act as an important link to other specialist services. This will help to identify when other services should be engaged and help their patients access them. For example, cardiac rehabilitation, social care or palliative care
• Provide education to, and upskill, generalist primary care teams, enabling them to take over the management of heart failure patients
• Encourage a more holistic approach including consideration for psychological and social care needs.

Resources and further information

Programme evaluation

Find out more about these evaluated services.

• Heart Failure Nurse Service - executive summary
• Heart Failure Nurse Service - full evaluation
• Retrospective evaluation of the role of BHF Heart Failure Specialist Palliative Care Nurse

Service innovation portfolio

View the full portfolio of our evidence-based service innovation programmes. 

Contact us

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References

1  Conrad, N. et al (2017) Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals. The Lancet, Volume 391, Issue 10120, 572-580
2  NICE (2018) Chronic heart failure in adults: diagnosis and management. NICE clinical guideline 108.