Pumping Marvellous

With the best available evidence these new NICE Chronic Heart Failure Guidelines 2018 inform your healthcare teams of the best way to help you. The standards set out indicate to you what you should expect. Our founder Nick was on the guideline committee and these are his thoughts of what you should expect from your healthcare team based on the guidelines.

1. Your specialist team must include
   1. A doctor with a sub-speciality in heart failure (generally a cardiologist)
   2. A Heart Failure Specialist Nurse
   3. A healthcare professional with expertise in specialist prescribing of heart failure medicines
   4. The specialist team must work with your primary care team

The specialist team must directly involve you if appropriate to rehabilitation services, care for older people and palliative care services.

Once you are stable and you are optimised on your drugs it is the responsibility of your primary care team to take over your management. If you go on to experience further difficulties you should expect to be go back into the specialist heart failure team.

2. Your specialist team must write you a care plan. A care plan is a document that tells you, your carer or family member and your healthcare team how to treat and care for your needs
   1. Your specialist team needs to write you a care plan
   2. It must summarise your treatment and care
   3. You must be given a copy along with your carer or family if you want, along with your healthcare team and or any other health or social care professional involved in your care

NICE stands for the National Institute for Health and Care Excellence and offers guidance to your Doctors, Nurses and other healthcare teams on the best way to help treat and care for you.

2018 has seen updated guidance by NICE for the management of chronic heart failure in adults with the NICE Chronic Heart Failure Guidelines 2018 with considerable changes made since 2003 and 2010. It is recommended that you read the full guidelines which can be found at www.nice.org.uk/guidance/cg***. Here are some highlights, with emphasis on how they relate to practice in Primary Care.

The MDT role has been emphasised and how this links in with primary care. The MDT should consist of a specialist with a sub-speciality in heart failure, responsible for making the diagnosis, a Heart Failure Specialist Nurse, a healthcare professional with specialist prescribing expertise in heart failure. The role of the MDT is to diagnose, give information to those newly diagnosed with heart failure, optimise treatment, commence new medicines that need specialist supervision, manage complex patients e.g. NYHA III and IV, those who are not responding to treatment, and those who have had a complex cardiac device inserted. The MDT should also take the role of referring patients to supportive services such as older peoples team.

This team should also continue to support patients, ensuring communication between various services, recall and review the patient every six months, share any  updates with the patient and the MDT and take over the care of a heart failure patient when they are stable and treatment optimised.

Each patient should have their own care plan describing follow-up care, symptom recognition, rehabilitation and social status, the named co-ordinator of care and how to access resources for patient information and support. Primary care should have a summary detailing diagnosis and aetiology, medicine management and the patient’s functional and social status.

See the diagnostic algorithm, of note is that NTproBNP should be taken if measure is >2000 ng/l (>236pmol/l) referral urgently for review within 2 weeks, if NTproBNP 400-2000ng/l (47-236pmol/l) should be referred for review within 6 weeks.

See the diagnostic algorithm, of note is that first line treatment should constitute ACE inhibitor, beta-blocker and MRA diuretic.

See algorithm – updated guidance relates eGFR and chronic kidney failure to the prescribing of treatment.

There has been an emphasis on addressing the need for good communication and supportive patient education. Discuss the patient’s diagnosis and prognosis in an open and sensitive manner, encourage patients and their families and carers to ask questions and provide information when needed throughout their care.

Long-term oxygen therapy should not be used for patients with advanced heart failure, unless underlying conditions present such as chronic obstructive hypoxic pulmonary disease. Patients with heart failure should have their condition discussed with the heart failure MDT.

Offer patients a structured programme including monitoring, physical activity and psychological support.

Do not routinely advise patients to restrict their salt and fluid intake but review on a regular basis.

We hope you have learn’t some important nuggets of information about how you should be treated and cared for as indicated in the new NICE Chronic Heart Failure Guidelines 2018. Remember these are just some of the changes to the existing 2003 / 2010 guidelines. You can find the new guidelines here.

We see these as an enhancement of the existing guidelines but guidelines will only be effective if people hold the implementors to account. So as a patient know what you are entitled to.