Managing heart failure

Reductions in mortality due to heart disease and stroke over the years have been remarkable and a cause for celebration. However, recently the continued improvement in mortality rates has slowed and impacted overall mortality rates in the UK (Public Health England (PHE), 2018) as well as in many other countries. Simultaneously, hospital admissions due to heart failure have increased by 33% in England (65 025 in 2013/4; 86 474 in 2018/19), reflecting the increased number of people living with heart failure (British Heart Foundation (BHF), 2019).

‘It is estimated that there are about 920 000 people living with heart failure in the UK, which exceeds the number with the four most common cancers combined and imposes a significant healthcare demand.’

It is estimated that there are about 920 000 people living with heart failure in the UK, which exceeds the number with the four most common cancers combined and imposes a significant healthcare demand. Several factors are driving the increased numbers of those with heart failure, namely, an ageing and growing population, increased survival after heart attacks and high rates of high blood pressure and diabetes in the population (BHF, 2019). The latest National Heart Failure Audit (National Institute for Cardiovascular Outcomes Research, 2018) of hospital admissions in England and Wales (2016/17) found a median patient age of 80.6 years, with only one-third of admissions being associated with symptoms at rest and minimal exertion (indicating stage III/IV heart failure). Interestingly, one-third of those admitted to hospital had diabetes and just under 20% had chronic obstructive pulmonary disease, indicating the impact of comorbidities. The audit found that post-discharge mortality rates at 1 year were independently associated with admission to a cardiology ward (versus care of the older person, general medicine or other), cardiology follow-up and the use of key disease-modifying medicines for heart failure with reduced ejection fraction (HFrEF). In light of this information, district nurses may wish to confirm that their clients with heart failure are receiving a cardiology follow-up and the appropriate medication on discharge in line with the recommendations of the National Institute for Health and Care Excellence (2018) and that their symptoms are well managed to maximise quality of life.