New NICE guidance and first nurse audit in heart failure

Br J Cardiol 2018;25:131–132 Leave a comment
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The National Institute of Health and Care Excellence (NICE) has published a new guideline on the diagnosis and management of chronic heart failure in adults (NG108). It updates and replaces the last heart failure guidance published in April 2010.

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The new guideline includes new and updated recommendations on:

  • role of the specialist HF multidisciplinary team
  • diagnosing heart failure and giving information to people with HF
  • managing all types of heart failure
  • treating heart failure with reduced ejection fraction, including people who also have chronic kidney disease
  • monitoring treatment for all types of heart failure
  • interventional procedures
  • cardiac rehabilitation and palliative care.

Full guidance can be accessed at:

Nurse audit

The first heart failure nurse audit has been published by the Pumping Marvellous Foundation, the main heart failure patient charity in the UK. The audit was one of the 2016 recommendations of the All Party Parliamentary Inquiry into Heart Failure.

Despite the acknowledged benefits of the heart failure specialist nurse role, there is variable access to these specialists across the country, and also anecdotal evidence that posts are being lost due to decommissioning, failure to recruit or nurse retirement. There is also no definition of their role, exact numbers, localities, skill levels and qualifications.

The audit, carried out from October 2017 to January 2018 on 165 organisational teams comprising 532 full-time nurses, found:

  • Heart failure specialist nurses were highly specialised and experienced: 73.4% of were able to admit patients directly into hospital, 100% were able to order significant investigations, and 70% of nurses were independent non-medical prescribers
  • The biggest concern of heart failure nurses was the significant case-load they were managing and increasing demand on their services without further resources
  • 60% of teams did manage those patients who had heart failure due to preserved ejection faction, however this resulted in 40% of patients, who were often highly complex patients, being unable to access support
  • Teams frequently operated in distinct settings (hospital or community) with only 28.5% of teams crossing the community/ secondary care setting
  • 84% of teams had access to a multidisciplinary team, but only 44% included a physician with a sub-speciality in heart failure
  • Heart failure specialist nurses loved their job, they described their passion, dedication, for the role, feeling valued by clinicians and patient, providing holistic and high-quality care.

“With the heart failure specialist nurse being clearly placed at the centre of the defined multidisciplinary team, we should not be letting patients down by not making them available where the evidence guides us,” says the report.

The data has already begun to generate significant interest with several clinical networks asking for anonymised data for their area to identify services and address equity of care.
The full report is available at;

Heart failure tops unplanned hospital admissions in over 65s

Heart failure currently tops Europe’s most common cause of unplanned hospital admissions for people over 65 and is also the leading contributor to unplanned readmissions. Hospital admissions due to heart failure are projected to increase by 50% over the next 25 years.

This has led the Heart Failure Policy Network – an alliance endorsed by 35 leading patient advocacy, scientific and professional organisations working in heart failure, cardiovascular disease and healthcare management – to lobby for governments to make better care for people living with heart failure. The “routine and tragic gaps” in the care of this condition, it says, can lead to avoidable suffering and death.

After discharge from hospital for an acute episode of heart failure, one in four people is readmitted within one month, and two in three are readmitted within one year, with over £2 billion spent treating the condition every year in England. The alliance makes their call for action in a report available at:

Other news items in BJC Issue 4, 2018:

European patient survey shows cancer-associated thrombosis
Preventing potentially fatal anaesthetic accidents
Future advances in bifurcation stenting?
Peripheral arterial disease assessment training tool
News in brief