What are the clinical issues?
- HF is associated with the second poorest survival rate when compared with cancers of the breast, bladder, bowel, ovarian and prostate. The median survival time is 16 months.
- The NICE Heart Failure model provides the principles for the model of care which should ensure people receive the right care, at the right time, by the right team and in the right place.
- Comorbidities with HF patients are common
- The Diagnostic Algorithm provides for primary care and all practitioners should be informed and confident in its use, as patients are missed at primary care level. The role of NT proBNP is central to the diagnosis as a rule-out test.
What are the implications and answers?
- A core specialist heart failure multidisciplinary team (MDT) should be established and work with primary care. It should include a lead physician, a specialist heart failure nurse and a healthcare professional with expertise in specialist prescribing for HF (clinical pharmacist).
- Once therapy has been selected and patient is stabilized, the primary care team should take over management.
- There should be 6-monthly follow-up in primary care to ensure better outcomes for HF patients.
- Increased information provision should be ensured for all patients with HF to allow better understanding of the options and uncertainties of their condition.
- Sacubitril/valsartan use is recommended for treatment of symptomatic chronic HF in patients with NYHA class II-IV, ejection fraction <35% and on a stable dose of ACE-inhibitors or angiotensin-receptor blockers.
- Mineralocorticoid receptor antagonists (MRAs) should also be offered to patients symptomatic on an ACE inhibitor/ARB and β-blocker. Primary care can initiate this therapy.
- The community heart failure nurse, has the opportunity to really understand the patients’ problems and be proactive in advising the MDT team on managing the individual patient.
Link to resources:
NICE guideline (NG106). Chronic heart failure in adults: diagnosis and management. Published September 2018 https://www.nice.org.uk/guidance/ng106