Heart failure represents a serious challenge for the health service. It accounts for 2 per cent of all NHS inpatient bed days and 5 per cent of all emergency medical admissions to hospital. Hospital admissions for heart failure are expected to rise by 50 per cent over the next 25 years, largely because of the ageing population and the accompanying increase in the underlying causes of heart failure, such as coronary heart disease.
In spite of numerous evidence-based guidelines on best practice for treatment, and substantial direct healthcare expenditure in this area, too few patients with heart failure receive the interventions they need, when they need them.
The report focuses primarily.on what works in the delivery of heart failure services to ensure that people receive an adequate diagnosis and appropriate treatment. It also looks at ongoing management and what to do when patients deteriorate.
Among the conclusions, the report finds evidence to support the delivery of chronic care interventions in multiple ways, including specialty clinics, home-based interventions and disease management programmes - no one model emerged as superior.
It also concludes that chronic care management activities can be delivered effectively by nurses with advanced training and support with back-up from physicians. Interestingly, it finds some evidence to suggest that, compared with GPs, cardiologists provide care that is more consistent with guidelines and have better patient outcomes (especially for those taking ACE inhibitors or beta blockers).
The report states that starting care management strategies during the inpatient hospital stay can lower the risk of readmission. In addition, the evidence in the report supports transitional care starting during the hospital stay and continuing into the community with support from an advanced practice nurse. The authors conclude that this can reduce the length of hospital stays and the risk of readmission.