A new at-home treatment for heart failure

A patient receiving intravenous diuretics at home

A new BHF initiative may mean an end to weeks in hospital for people with severe heart failure, as June Davison reports.

You’re probably no stranger to overnight stays in hospital if you have severe heart failure. Now, an innovative pilot project means that many patients can be treated for excessive fluid retention – a common symptom – in their own homes for the very first time.

If successful, this BHF-funded initiative could be rolled out across the UK, potentially improving the lives of thousands of people with this condition while creating huge cost savings for the NHS.

The project, which began in September 2011, involves training heart failure nurses at 11 NHS UK sites to administer the treatment in a home setting.

It’s early days but, so far, things are looking good. Evidence to date suggests it’s a safe, effective and viable alternative to hospital-based treatment. In an interim evaluation report, all patients stated that they would opt to be treated at home again. Plus there are cost benefits. Providing this treatment in people’s homes could save individual NHS trusts thousands of pounds a year.

The BHF will continue to monitor and analyse the pilot programme and complete a final evaluation by the end of 2013, so watch this space for more news.

Meanwhile, we talk to BHF specialist nurse Chris Watson, who’s been leading the programme for East Sussex Healthcare NHS Trust since November 2011.

Why is this project needed?

In the earlier stages of heart failure, fluid retention can be controlled with water tablets, known as diuretics, which make the excess fluid pass out of your body in urine. But as the disease progresses, the tablets aren’t always effective enough, so sometimes the diuretic has to be administered intravenously – that is, straight into your bloodstream – using a small plastic tube called a cannula.

Up until now, this treatment has always been carried out in hospital, but the BHF’s two-year pilot programme is funding specialist nursing teams to treat people either at home or in nearby community clinics instead.

This means patients can avoid the stress and upheaval of a hospital stay, while reducing healthcare costs. And because many of them are elderly and more susceptible to infections, keeping them out of hospital also helps protect them from this risk.

What happens during the treatment?

Heart failure nurses refer patients to me if their fluid retention symptoms are getting worse, they’ve stopped responding to their water tablets and they need the treatment intravenously.

When I first visit, I do a pre-assessment and explain how the service works, and that hopefully the treatment will improve their symptoms. I make sure that they understand what will happen and agree to it, then I do some checks, including taking their blood pressure.

I usually return the next day and put the drug through a little pump, which goes through a cannula into a vein in their arm. It takes about 20 minutes and I stay with them the whole time. Afterwards, I check their blood pressure and talk to them and their carer about any potential effects such as dizziness, and I also call them later to check how they are. Some people might need the treatment twice a day, so I’ll go back to give them another dose.

Is there any feedback yet?

In my experience, patients think it’s great, as going into hospital can be quite stressful and often affects how people sleep and eat. At home they can just carry on as normal. They also like having the personalised service and the continuity of seeing the same nurse, and they like having someone to call if they have any concerns or questions. It’s better for the family, too, as they aren’t restricted by visiting hours. Plus it saves carers – who are often elderly themselves – having to travel to the hospital.

Is it suitable for everyone?

It’s important that we make it as safe as possible, so you need to have had the treatment previously in hospital without experiencing any problems. You must also have someone at home with you, just in case of adverse reactions later on. Your blood pressure and kidney function have to be stable, too.

What is heart failure?

Heart failure happens when a person’s heart becomes less efficient at pumping blood around the body. It usually happens when the heart has been damaged because of a heart attack or as a result of certain conditions, such as high blood pressure or cardiomyopathy, a disease of the heart muscle.

Heart failure affects more than 570,000 people in the UK and can be debilitating and affect quality of life in some cases.

Because the heart isn’t pumping as well as it should, it can cause a build-up of fluid in the bloodstream. Excess fluid can leak into the body’s tissues, causing swelling in the legs and feet. Fluid can also build up in the lungs, causing breathlessness, and you may feel unusually tired.

Symptoms of heart failure vary, and some people will have few or no symptoms, depending on the severity of their condition.

However, if you have severe heart failure, you may be breathless a lot of the time. If the fluid build-up in your lungs becomes more frequent and doesn’t respond to treatment, it can be serious and even life-threatening.

Our Mending Broken Hearts Appeal funds research that gives hope to people with heart failure. To find out more or donate, call 0300 330 3322 or visit our Mending Broken Hearts page.

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