Nursing care and education in heart failure

The number of patients with heart failure has steadily increased during recent decades and the cost of frequent hospitalizations has had a strong economic impact on health care services. The compliance and education in heart failure patients are poor, and only a small proportion of the patients are on optimal therapy. Therefore, it is justified to build up specific heart failure units. Eight years ago we started the first physician-nurse based outpatient heart failure clinic in Sweden, where the nurses after passing an examination in heart failure have special authority to handle this type of patient. The nurses may introduce and uptitrate the dose of ACE inhibitors and beta-receptor blocking drugs, perform and early follow-up of all patients discharged from hospital because of heart failure, perform close follow-ups in patients with severe heart failure, and inform and educate the patients and their family members in self-care. We have also created a computer-based information program to enhance the compliance in our patients. The number of patients hospitalized in our hospital has decreased during the last 5 years and patients discharged from the hospital because of heart failure are mostly on treatment with ACE inhibitors (93%), and whether this is due to the work by the people in the heart failure unit or not is under evaluation in an ongoing randomized study. We believe that this model with a physician-nurse based organization in the management of heart failure creates increased safety and self-confidence in our patients and increase their motivation to follow prescribed medication and improve quality of life and prevent the need for further hospitalization.