Heart Failure – Education, Identification and Support in the Community Setting

There are approximately one million people living with heart failure (HF) in the United Kingdom, with 200,000 new diagnoses annually (NICE 2018) and at least 400,000 undetected, currently unaware they have the condition.

As an advanced nurse practitioner in primary care, and a specialist nurse working with heart failure patients since 2014, I have witnessed the demands that this condition imposes not only on the person living with the condition and their loved ones, but also on the services that provide treatment, care, and support. Frequent hospital admissions, life-limiting symptoms and poor quality of life are all too common realities of heart failure, but with access to specialist assessment and care and treatment with guideline-directed, disease-modifying medical therapy, outcomes can be vastly improved.

With the prevalence of HF set to double by 2040 due to our burgeoning, ageing population (The Health Foundation 2023), we recognise increasingly that we need to change our overall approach to HF to reduce the significant mortality and morbidity burden and better meet the needs of those with the condition.

The 25in25 Initiative

In March 2023, the British Society for Heart Failure (BSH), the professional association for heart failure care across the four nations of the UK,  in conjunction with 45+ other healthcare organisations (from Public Health to British Heart Foundation, Association for the Study of Obesity to GIRFT), launched the 25in25 Initiative.

Through the implementation of the initiative in selected ‘Fast-Track Heart Failure Communities’, the ambition is to reduce HF mortality by 25% in the first year of diagnosis over the next 25 years by improving identification of those at risk of developing HF, ensuring accurate and timely diagnosis, providing evidence-based treatment, and working to improve the quality of life of those living with a HF diagnosis.

The 25in25 initiative is a huge, yet achievable ambition which will set the agenda for the direction of HF care and in which we, as health care professionals can collectively play our part in improving care with small, simple measures across our health care teams and the wider healthcare system landscape.

Heart failure is the endpoint of most cardiovascular disease and many non-CVD.

As a condition, HF rarely exists in isolation. These patients are often living with other co-morbidities such as obesity, coronary artery disease, COPD, chronic kidney disease and diabetes (to name but a few), and as a result will most likely be attending other medical, nurse or allied health professional led clinics in primary and secondary care, and in the community.

Identifying Those at Risk

Do you know how to identify who is at risk of HF and when to be concerned? Do you know how to get them on the pathway to assessment, diagnosis, and treatment?

Education, specifically about what HF is, what it looks like, and what to do when you suspect it, is key to early diagnosis. This is true particularly for detecting currently undetected HF, which in turn is key to accessing specialist treatment and care. It is incumbent upon all HF professionals to make every effort to educate, engage, and support colleagues working in all these, ultimately connected, other areas. While there is no guidance in how to do this, forging relationships between different services and disciplines can prove invaluable.

You will hopefully have access to HF nurses in your area, so I recommend you find out who they are. Invite them to speak to your team to gain a better understanding of what they do, and what they offer as a service. Discuss how to develop local pathways and partnerships that create opportunities for inter-specialty and interdisciplinary working. You may wish to make use of the BSH Pathway online guide for reference.

Most importantly, it is crucial to make every contact count because this is one of the key ways we are going to detect undetected HF.

Heart Failure Awareness Week 2024

This year, for a second year, the Heart Failure Association of the European Society of Cardiology has adopted ‘25in25: Detecting the Undetected’ with the addition of the F word: ‘Find Me’, as the theme for the Heart Failure Awareness Week, 29 April to 5 May 2024.

The Freedom from Failure F words are an easy way to identify the main symptoms of HF: Fighting for breath; Fatigue and Filling with fluid – if you see these symptoms, give a simple test (NTproBNP) to rule out HF or confirm the need for further tests such as echocardiogram for HF. With every conversation, meeting, and examination we should be thinking about how we can identify HF and make sure that our patients get timely access to the lifesaving care they need. We can all agree that reducing HF deaths by 25% over the next 25 years can only be a good thing, and we have a responsibility to get involved.

Teresa O’Nwere-Tan

ANP in Primary Care for Nexus Health Group

Heart Failure CNS, MSc, NMP, QN.

REFERENCES

The Health Foundation, 2023. Health in 2040: projected patterns of illness in England [internet]. [Cited 11 February 2024]. Available from Health in 2040: projected patterns of illness in England – The Health Foundation
NICE (National Institute for Health and Care Excellence). 2018. Chronic heart failure in adults: diagnosis and management [internet]. [Cited 11 February 2024]. Available from Chronic heart failure in adults: diagnosis and management (nice.org.uk)

25IN25 — British Society For Heart Failure (bsh.org.uk)

British Society for Heart Failure (bshpathway.org.uk)

 https://www.bsh.org.uk/the-f-word

 Pumping Marvellous | The UK’s Heart Failure Charity

Watch a moving video from the British Society for Heart Failure here: ‘Detect the Undetected: Find Me.’