New Survey Data Reveal Need For Specialist Nurse Support In Management Of Patients With Heart Failure In UK
One year after the publication of the European Society of Cardiology (ESC) Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012,[i] awareness amongst UK healthcare professionals varies dramatically.[ii]
Results of a new survey commissioned by Pfizer found that just 36% of GPs are aware of the guidelines compared to 92.9% of cardiologists, 82.8% of secondary care cardiac nurses and 50.7% primary care nurses with a specialist interest in cardiology.[ii] The findings indicated a need for those in primary care to become more familiar with these best practice guidelines.
Commenting on the survey findings, Professor Ahmet Fuat, Professor of Primary Care Cardiology and GP with a special interest in Cardiology, Darlington said: “This survey demonstrates that GPs are not as well informed about the ESC guidelines as they could be. As the UK-specific guidance for the care of patients with chronic heart disease is less up-to-date, the ESC Guidelines are the best resource available to healthcare professionals caring for these patients. GPs should look to their specialist nursing colleagues for support because they play an essential role in care, assessment and monitoring in this area, and can assist healthcare teams by ensuring that patients are managed according to best practice.”
A key difference between the 2012 Guidelines and previous editions is the recommendation for the addition of a mineralocorticoid receptor antagonist for all patients with persisting symptoms (NYHA class II-IV) and an EF ≤35% to reduce the risk of heart failure hospitalisation and the risk of premature death. This is in addition to treatment with an ACE inhibitor (or an ARB if an ACE inhibitor is not tolerated) and a beta-blocker.[i] The healthcare professionals surveyed said that one in three chronic heart failure patients remained symptomatic following treatment with an ACE inhibitor (or an ARB if an ACE inhibitor is not tolerated) and a beta-blocker.[ii]
“It is vital that people with heart failure in the UK are treated to the best international standards: old fashioned treatment robs patients of potential benefits in terms of both their length and quality of life. Hospital based specialists appear to be very up-to-date in this survey, but many patients do not see specialists very often, so if we are to help people benefit from modern therapies it is vital that every heart failure patient is seen by someone with up-to-date knowledge in the field.
Specialist heart failure nurses have a vital role in helping to implement current best practice, and can be a very important link between primary and secondary care. It is only by cascading up-to-date knowledge throughout the NHS that we can hope to offer patients up-to-date treatment that can improve their lives and reduce the need for urgent admission to hospital” said Professor Martin Cowie, Consultant Cardiologist at the Royal Brompton Hospital, London.
Heart failure affects 1% of people in the UK.[iii] Survival rates for heart failure in epidemiological studies are worse than for breast and prostate cancer,[iv] with annual mortality ranging from 10% to 50% depending on severity.[v] Furthermore, patients with heart failure have a poor quality of life, with over a third experiencing severe and prolonged depressive illness.[vi]
The NHS spends 2% of its total budget on chronic heart failure[vii] and 70% of these costs are due to hospital admissions.[viii] Around 1% of emergency hospital admissions involve people with a primary diagnosis of heart failure.[ix]
About the survey
The survey was designed to gather information about knowledge and implementation of recommendations for the use of mineralocorticoid receptor antagonists (MRAs) set out in the European Society of cardiology Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Responses were collected between 29th April and 6th May from 270 healthcare professionals in the UK, including 100 general practitioners, 70 cardiologists and 100 nurses. Of the 100 nurses, 71 were primary care nurses with a specialist interest in cardiology and 29 were secondary cardiac nurses.
[i] European Society of Cardiology. (2012) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Available here (PDF). Accessed May 2013
[ii] Survey commissioned by Pfizer. May 2013
[iii] Townsend et al. Coronary Heart Disease Statistics. 2012 Edition. British Heart Foundation: London
[iv] NICOR National Heart Failure Audit 2010-11
[v] NICOR National Heart Failure Audit 2011-2012
[vi] Jiang et al. Arch Intern Med. 2001; 161(15):1849-56
[vii] National Clinical Guideline Centre. (2010) Chronic heart failure: the management of chronic heart failure in adults in primary and secondary care. London: National Clinical Guideline Centre. Available from: http://guidance.nice.org.uk/CG108/Guidance/pdf/English. Accessed May 2013
[viii] McMurray et al. Eur Heart J Fail. 2006; 27: 1447-1458
[ix] NHS information Centre. Hospital Episode Statistics for England. Inpatient statistics. 2011-12. Primary Diagnosis: Summary available at: http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=202. Accessed May 2013