Improving heart failure care at home

Around 920,000 people in the UK have heart failure and it’s placing a significant burden on the health service, causing over 100,000 hospital admissions across the country each year. There is no cure for heart failure (apart from a heart transplant in a small number of severe cases).

But with access to the right services and support, people can go on to have a good quality of life for many years. We’ve been developing and testing new ways of delivering care for heart failure patients, including at home, to improve thousands of lives and relieve the pressure that heart failure is putting on our health service, so that more people can be treated.

Demonstrating the value of specialist heart healthcare professionals

Between 2004 and 2007, the BHF evaluated a home-based heart failure programme led by heart failure specialist nurses. We funded 76 nurses in 26 NHS primary care organisations in England who saw approximately 15,000 patients. This programme led to in a 35% reduction in hospital admissions, and significant cost savings. Thanks to this work, heart failure specialist nurse services are now well-established in many areas of the UK.

Testing the administration of intravenous diuretics at home

As the symptoms of heart failure worsen, fluid builds up in the lower limbs and eventually in the lungs and abdomen, which can cause breathlessness. Diuretics (water tablets) may help reduce fluid retention, but as heart failure progresses, or when it flares up, tablets may no longer be enough to control the symptoms. People can become too sick to stay at home and may need admission to hospital for intravenous (through a vein) diuretic treatment, typically involving a stay of several days or longer. In 2011, we supported heart failure specialist nurses to help give people intravenous diuretics at home. This pilot was successful and showed that 100% of patients and 93% of their loved ones preferred home-based treatment to hospital admission. It also showed that intravenous diuretics, when given at home, are safe, cost effective and they work.

Reaching more heart failure patients with online cardiac rehabilitation programmes

Research funded by us and others has demonstrated that cardiac rehabilitation improves the day-to-day life of people with heart failure. But today, we know that only a minority (around one in seven) of people with heart failure get referred to cardiac rehab when they go home from hospital. Many cardiac rehab services don’t offer programmes to heart failure patients unless they have also had a heart attack or surgery. Also, these potentially life-saving services, which are usually done in group sessions, have in most cases not been running during the Covid-19 pandemic.

So in 2020 we produced a cardiac rehabilitation online information hub to offer information about exercising safely, healthy eating and medications. This includes an online exercise programme which is specially designed for cardiac rehab patients. By April 2021, this had been viewed more than 250,000 times.

Improving end-of-life care for heart failure patients

In its severe form, heart failure has a life expectancy worse than many cancers. And there is no cure. So it’s vital that people with advanced heart failure get the best quality care in the last stages of their life. Sadly, this is not always the case and people with heart failure are less likely than those with cancer to be offered specialist palliative care.

In 2011, we launched Caring Together in partnership with Marie Curie and NHS Greater Glasgow and Clyde, a programme involving heart failure palliative care specialist nurses to improve the quality of palliative and end-of-life care for patients in the advanced stages of heart failure. This work led to better management of symptoms and quality of life and reduced hospital admissions. It also helped people with heart failure and their loved ones to plan for end of life.

It’s now recognised that home-based heart failure services are a good way of caring for and managing people with heart failure, including towards the end of life. But the access and quality of those much-needed services are still variable across the country.

The BHF launched a report ("Heart Failure: A blueprint for change") and campaign in 2020 highlighting the main barriers to improving heart failure care. We have also called for key areas for change to deliver high quality consistent heart failure care across the UK, including home or community-based care. We are continuing to work for the best possible care for people with heart failure.

First published 1st June 2021