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Nurse-led, Home-based Management of Chronic Heart Failure
Patients with heart failure account for about 5% of acute medical admissions to hospital and 10% of bed occupancy.1 Intervention by a specialist nurse can substantially reduce the risk of readmission to hospital for heart failure.2 Nurse leadership of such programmes has also been successful in terms of reduced hospital admission rates, improved quality of life and cost savings.3
Both models of care principally rely on the appointment of a specialist heart failure nurse to provide health care designed to optimize drug therapy, promote self-care (e.g. fluid and dietary management), provide a means for early detection of clinical deterioration and apply more appropriate follow-up according to the needs of each patient.4
- Clinic-based service:
- Involves the establishment of a specific heart failure clinic that is usually situated in the hospital outpatient department.
- Follow up after hospitalisation at a nurse-led heart failure clinic can improve survival and self-care behaviour in patients with heart failure as well as reduce the number of events, readmissions and days in hospital.5
- This model has proven to be less effective than home-based intervention but has the potential to reduce all-cause hospital readmissions and associated hospital bed utilisation.4
- Home-based service:
- Has proven to be the most consistent and effective strategy in reducing heart failure and all-cause hospital readmissions in typically older heart failure patients.
- This model appears to have an even greater effect on associated hospital bed utilisation by reducing days of readmission by up to 60% relative to usual care.4
- The beneficial effects of a multidisciplinary home-based programme for the management of patients with chronic heart failure in reducing frequency of unplanned readmissions persist in the long term and are associated with prolongation of survival.6
- Hybrid service:
- Comprising home plus clinic-based follow-up.
- Qualified specialist nurse who is able to work as an autonomous practitioner.
- Regular follow-up and assessment, including blood chemistry, to detect early clinical deterioration.
- Continued adjustment and optimisation of therapy according to agreed protocols.
- Promotion and support of self-management, including daily monitoring of weight.
- Education: including both pharmacological and non-pharmacological aspects of care, including exercise and nutrition advice.
- To act as an intermediary between the patient and other professionals, e.g. cardiologists and the primary health care team.
- Provide support for patients and their carers.
Document References
- British Heart Foundation Factfile; Nurse-led, Home-based Management of Chronic Heart Failure. September 2002.
- Blue L, Lang E, McMurray JJ, et al; Randomised controlled trial of specialist nurse intervention in heart failure. BMJ. 2001 Sep 29;323(7315):715-8. [abstract]
- McMurray JJ, Stewart S; Nurse led, multidisciplinary intervention in chronic heart failure. Heart. 1998 Nov;80(5):430-1.
- Stewart S, Blue L, Walker A, et al; An economic analysis of specialist heart failure nurse management in the UK; can we afford not to implement it? Eur Heart J. 2002 Sep;23(17):1369-78. [abstract]
- Stromberg A, Martensson J, Fridlund B, et al; Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failure: results from a prospective, randomised trial. Eur Heart J. 2003 Jun;24(11):1014-23. [abstract]
- Stewart S, Horowitz JD; Home-based intervention in congestive heart failure: long-term implications on readmission and survival. Circulation. 2002 Jun 18;105(24):2861-6. [abstract]
DocID: 2527
Document Version: 20
DocRef: bgp24513
Last Updated: 28 Aug 2007
Review Date: 27 Aug 2009
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