European Society of Cardiology Heart Failure Association Standards for Delivering Heart Failure Care

Theresa A. McDonagh; Lynda Blue; Andrew L. Clark; Ulf Dahlström; Inger Ekman; Mitja Lainscak; Kenneth McDonald; Mary Ryder; Anna Strömberg; Tiny Jaarsma

Disclosures

Eur J Heart Fail. 2011;13(3):235-241. 

In This Article

Abstract and Introduction

Abstract

The management of heart failure (HF) is complex. As a consequence, most cardiology society guidelines now state that HF care should be delivered in a multiprofessional manner. The evidence base for this approach now means that the establishment of HF management programmes is a priority. This document aims to summarize the key elements which should be involved in, as well as some more desirable features which can improve the delivery of care in a HF management programme, while bearing in mind that the specifics of the service may vary from site to site. We envisage a situation whereby all patients have access to the best possible care, including improved access to palliative care services, informed by and responsive to advances in diagnosis management and treatment. The goal should be to provide a 'seamless' system of care across primary and hospital care so that the management of every patient is optimal, no matter where they begin or continue their health-care journey.

Introduction

Heart failure (HF) is a common chronic medical problem, which is associated with considerable morbidity and mortality.[1] Despite the decline in prevalence of other cardiovascular conditions, the prevalence of HF continues to rise, partly due to the changing demography of the European population and also due to better survival from cardiovascular disease earlier in life.[2,3]

We now have nearly 20-year worth of clinical trial results both for drugs and devices which provide a strong evidence base for treatments which reduce both morbidity and mortality in HF.[3–6] That evidence base has led to practice guidelines which have been published and updated as required, and these guidelines are the basis for allowing health-care professionals to deliver the best, evidence-based care to patients.[7–9] The guidelines are thus important tools in clinical governance. In addition, many of the performance indicators health-care providers are measured against are benchmarks taken from the guidelines.

Despite the plethora of publications and guidelines, European community-based studies and registry data consistently show a lower uptake than expected of evidence-based investigations and therapies, and concomitantly higher rates of hospitalizations for HF and mortality than those reported in the clinical trials.[10,11] There has thus been a paradigm shift away from concentration on individual drug therapies to the systems of care in which treatments are delivered, i.e. within organized multiprofessional HF services.

As a result, in the last few years, several randomized controlled trials of multiprofessional/organized/managed care vs. usual care have been carried out.[12–16] They are heterogeneous in nature in terms of the models of care they have employed including: multiprofessional HF clinics, multiprofessional follow-up without HF clinics, telephone contact, primary care follow-up, and enhanced patient self-care. Most have used specialist personnel including cardiologists and HF specialist nurses within the multiprofessional team. A recent systematic review of 29 of these trials showed that specialized multiprofessional care in the clinic or non-clinic setting reduced mortality by 25%, HF hospitalizations by 26%, and all-cause hospitalizations by 19%.[17] The vast majority of the trials of managed or systematic organized HF care have concentrated on patients who have had a recent admission to hospital with HF.

Following on from this, most cardiology society guidelines now state that HF care should be delivered in such a multiprofessional manner. The evidence now means that the establishment of HF management programmes is a priority.

In setting up an HF management programme, consideration should be given to several areas involving both content and organizational issues.

This document aims to summarize the key elements which should be involved, as well as some more desirable features which can improve the delivery care in an HF management programme, while bearing in mind that the specifics of the service may vary from site to site. We envisage a situation whereby all patients have access to the best possible care, including improved access to palliative care services, informed by and responsive to advances in diagnosis management and treatment. The goal should be to provide a 'seamless' system of care across primary and hospital care so that the management of every patient is optimal, no matter where they begin or continue their health-care journey.

The following issues are addressed:

  1. the complexity of HF care

  2. general points about HF management programmes

  3. specific points about HF management programmes

    1. personnel

    2. the central role of guidelines

    3. the role of outpatient clinics

    4. diagnostic services

    5. therapeutic services

    6. follow-up and monitoring

    7. patients

    8. audit

    9. training issues

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