Secondary Care

This section is intended for non-cardiology secondary healthcare professionals only

This is Ruth, 43, from Buxton. She is fighting heart failure.

 


Heart failure is a common cause for hospital admissions in the UK1. Approximately 1 in 10 of patients admitted for heart failure in England and Wales die in hospital1. Of those surviving at discharge, about 1 in 3 die within a year2.

This highlights the importance of ensuring patients receive the interventions associated with improved long-term outcomes.

As a healthcare professional who may care for patients with heart failure in your daily practice, you should ensure:

  1. That all patients being admitted to hospital with suspected acute heart failure have early and continued input from a dedicated specialist heart failure team1. You can achieve this by making sure you are familiar with your local heart failure protocol and know how to get in touch with the HF specialist team.

  2. Organise a follow-up clinical assessment to be undertaken by a member of the specialist heart failure team within 2 weeks of the patient being discharged from hospital2,3. You can liaise with the HF team to ensure this is planned upon discharge.

  3. Heart Failure with Reduced Ejection Fraction (HFrEF) patients admitted to hospital are discharged on the appropriate disease-modifying medicines.1,2 Involve colleagues from the heart failure specialist team, as these patients may have multiple co-morbidities and be on complex medication regimens.

NCEPOD Heart Failure report recommendations (2018)

The NCEPOD report sets out some key recommendations for heart failure management in the acute setting. Please refer to the full report for more detail.

Below is a list of some of the recommendations which are particularly relevant to healthcare professionals who may be looking after a heart failure patient but are not heart failure specialists.

Selected list of NCEPOD recommendations4

  1. A guideline for the clinical management of acute heart failure should be available in all hospitals.
  2. All patients admitted with acute heart failure should be reviewed by a consultant within 14 hours of admission, or sooner as the clinical need dictates (e.g. cardiogenic shock or respiratory failure) and discussed with a member of the heart failure multidisciplinary team. For patients with worsening symptoms despite optimal specialist treatment, this discussion should include their palliative care needs.
  3. All heart failure patients should have access to a heart failure multidisciplinary team.
  4. Medications should be reviewed by a pharmacist with specialist expertise in prescribing for heart failure on admission to and discharge from hospital.
  5. Serum natriuretic peptide measurement should be included in the first set of blood tests in all patients with acute breathlessness and who may have new acute heart failure.
  6. An echocardiogram should be performed for all patients with suspected acute heart failure as early as possible after presentation to hospital, and within a maximum of 48 hours as it is the key to diagnosis, risk stratification and specialist management of acute heart failure.
  7. Due to the poor sensitivity of individual physiological parameters (in particular heart rate) in identifying severity of illness in acute heart failure, use of a composite physiology score such as the National Early Warning Score is recommended.
  8. All treatment escalation decisions that are not initially made by a consultant should be confirmed by a consultant at the earliest opportunity afterwards. The reasons for treatment escalation decisions should be fully documented in the patient’s records.
  9. On discharge from hospital, all acute heart failure patients should receive a summary that includes:
    • A named healthcare co-ordinator and their contact details
    • Their diagnosis and the cause of their heart failure
    • Current medications and description of any monitoring required
    • Individualised guidance on self-management
    • Functional abilities and social care needs
    • Follow up plans
    • Information on how to access the specialist heart failure team and urgent care

Listen to...

Dr Simon Williams of the British Society for Heart Failure explain the importance of NT-proBNP testing in patients presenting with symptoms of heart failure.

CVM19-C027l

 
Help us fight heart failure

Share what you’ve read today and together we can improve care for people living with heart failure across the UK.

I’m working to improve heart failure care in the UK. Together we can ensure every patient is diagnosed early and has access to a heart failure specialist.

#fightingfailure

   
 

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References

  1. NICE Acute Heart Failure guidelines. 2014. Available at https://www.nice.org.uk/guidance/cg187/resources/acute-heart-failure-diagnosis-and-management-pdf-35109817738693. Last accessed: September 2020.
  2. NICOR Heart Failure Audit 2017/2018. Summary report 2019.
  3. NICE. Chronic heart failure in adults: diagnosis and management. NG106. September 2018. Full guideline. Available online at: https://www.nice.org.uk/guidance/ng106/resources/chronic-heart-failure-in-adults-diagnosis-and-management-pdf-66141541311685. Last accessed: September 2020.
  4. NCEPOD Acute Heart Failure report. 2018. Available at https://www.ncepod.org.uk/2018ahf.html. Last accessed: September 2020.

CVM20-E011h August 2020

Fighting Failure is a disease awareness campaign that has been sponsored and funded by Novartis Pharmaceuticals UK Ltd.

© 2020 Novartis Pharmaceuticals UK Ltd.

Novartis Pharmaceuticals UK Limited is a private limited liability company registered in England and Wales under number 119006 Registered office 2nd Floor, The WestWorks Building, White City Place, 195 Wood Lane, London, W12 7FQ.

Reporting side effects
Adverse events should be reported. Reporting forms and information can be found at https://yellowcard.mhra.gov.uk/ (UK).

CVM20-E011b August 2020