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The number of heart failure specialist nurses should be doubled, or even quadrupled, to meet rising demand and the impact of Covid-19, according to a coalition of heart failure organisations.
The Alliance for Heart Failure argues in a new report that the current recommendation of one specialist heart nurse per 100,000 people needs to be increased to between two and four per 100,000 people.
“The shortage of specialist heart failure nurses was an issue long before the Covid-19 pandemic”
The report – Heart Failure: A call to action – said current recommendations, which were drawn up in 2002, were out of date because of an increased prevalence of heart disease, leading services to become overstretched.
At present, 84% of heart failure services meet the current recommendation of one specialist nurse per 100,000, according to the report, published today.
But the report argued there was evidence that services were overstretched, with only one in three specialist nurses managing to see two thirds of patients within two weeks of discharge.
It stated: “Community providers and acute trusts should urgently review and increase the number of heart failure specialist nurses, in the range of two to four whole-time equivalent per 100,000 population, to ensure numbers match workloads and patients are seen by highly skilled specialists.”
It also called for better awareness and education among clinicians. Professional bodies “should ensure members are aware of the high-quality patient education materials available via patient organisations”, the report stated.
In addition, it recommended initiatives to raise awareness of heart failure among the general public, a heart failure champion in each primary care network and an increase in the number of specialist echocardiographers.
There should also be greater use of simple N-terminal prohormone of brain natriuretic peptide (NT-proBNP) testing among GPs and others to eradicate regional variation, said the report.
Nearly one million people in the UK are affected by heart failure, with around 200,000 diagnosed every year before the pandemic, noted the alliance.
The report warned that Covid-19 could result in a significant increase in heart failure as people avoided treatment.
It estimated that two-thirds of patients with heart failure were not presenting at the moment, due to fears over the safety of visiting health facilities.
“Only six out of 10 achieved specialist review rates of over 80%. This postcode lottery for patients must be eradicated”
A 2016 inquiry into heart failure services, carried out by the All Party Parliamentary Group (APPG) on Heart Disease, concluded that good quality care for heart failure prolonged life expectancy and restored some quality of life.
However, widespread regional variation meant that service delivery was patchy, the APPG said.
The Alliance for Heart Failure said its report attempted to look at what progress had been made on the parliamentary group’s recommendations.
Louise Clayton, advanced nurse practitioner and co-chair of the Alliance for Heart Failure, said: “Early input by heart failure specialists, including nurses, has been shown to improve patient outcomes and reduce mortality.
“Around eight in 10 patients admitted with heart failure are now identified and seen by specialists during their admission, with around half seen by a specialist nurse,” she said.
But she pointed to “huge variation” between hospitals and added that Covid-19 had simply increased the need for action on shortages.
“In 2018, only six out of 10 achieved specialist review rates of over 80%. This postcode lottery for patients must be eradicated,” she said.
She added: “The shortage of specialist heart failure nurses was an issue long before the Covid-19 pandemic, but with more cases predicted to emerge as a result, it needs to be addressed more urgently than ever.”