The role of the specialist nurse.

Heart failure is growing in incidence as a result of the aging of the population and of improved survival from myocardial infarction. However, quality of life is poor among patients with heart failure, and has shown to be worse than in most chronic conditions.1 These patients often have a poor prognosis—around 50% of those with severe heart failure will die within the first year.2 Since this is a condition associated with high admission rates, high readmission rates, and lengthy hospital stays, heart failure is associated with a high financial burden; the annual direct cost of heart failure to the National Health Service (NHS) in 1990-91 represented over 1% of the total NHS budget.3 Against this background, there is increasing evidence to show the important role that specialist heart failure nurses can play in the management of patients with heart failure. Patients with heart failure are often frail and vulnerable. The condition can have devastating effects on patients’ quality of life, especially in a patient group that often has inadequate access to help and advice. This is mainly due to overstretched services in primary and secondary care. Patients are often on suboptimal treatments and are not receiving the best management, thus creating a huge potential for care to be improved. Often there is a lack of patient education and support. This can have a knock-on effect in terms of non-adherence both with pharmacological and non-pharmacological treatments. In addition, it has been shown that around 54% of readmissions to hospital for heart failure are preventable.4 Since heart failure management can be complex, there is a need for a health care professional to coordinate what can be a complicated map of care. Nurses may well be able to take on this role. Nurse led approaches to heart failure management …