Nurse-Led Heart Failure Services: A Review of the Literature

Abstract

Quality of care is defined as "the degree to which services... increase the likelihood of desired health outcomes and are consistent with current professional knowledge" (Institute of Medicine, 2001, p.2). Despite significant advances in understanding of the pathophysiology and treatment of heart failure including the development and application of efficacious therapies, the application of this knowledge remains sub optimal. Important targets for optimising the quality of heart failure care include clinical stability and adequate patient education, optimal usage and titration to target dose of angiotensin converting enzyme inhibitor (ACEI), beta blockers, with other indicated therapies, and early clinical follow up. This research paper reports on the findings of a literature review conducted to establish and analyse the international magnitude, context and effectiveness of nurse-led heart failure initiatives. The research revealed the underlying philosophy in establishing nurse-led disease management programmes of care, is that by treating chronic heart failure as a continuum, it is possible to decrease exacerbations and improve patient outcomes. Regardless of the type of heart failure management programme, critical components of care include a collaborative supportive approach, that educates and empowers the patient (including family/whanau) to recognise the early indicators of exacerbation, access expedient care and adhere to evidence based treatments. There is significant evidence to support the establishment of nurse-led heart failure programmes. The positive outcomes associated with this model of care delivery include, decreased readmissions, reduction in mortality and cost efficiencies. However the organisational model of care, or programme components that are the most effective in optimising patient outcomes, need to be selected on the basis of local healthcare infrastructure, services and resources. New Zealand has a unique opportunity to encompass the recent emergence of the Nurse Practitioner role in facilitating, coordinating and monitoring of heart failure programmes across the continuum of care. The delivery of evidence-based, cost effective, heart failure programmes is a prerequisite to improving the delivery of optimal treatment and ensuring that heart failure patients, have the opportunity to attain quality care outcomes.