Implementation of Beta-Blockade in Elderly Heart Failure Patients: Role of the Nurse Specialist

Mariani, Miriam; Vella, Giovanna; Bíanchi, C; Verde, S. Fidalgo; Maria, Renata De; Pirelli, Salvatore

doi:10.1016/j.ejcnurse.2007.09.006

Cited by 10 publications

(10 citation statements)

References 34 publications

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“…The specialist nurses’ main focus should be on patient education and the optimization of medical therapy 26,27. In some European countries, nurses are allowed to prescribe HF drugs, others can up‐titrate prescribed medical therapies, and all should be able to liaise with a hospital or community physician, so that the initiation or optimization of therapy is possible.…”

Section: Specific Points For Setting Up Heart Failure Servicesmentioning

confidence: 99%

European Society of Cardiology Heart Failure Association Standards for delivering heart failure care

McDonagh

Blue

Clark

et al. 2011

European J of Heart Fail

232

198

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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.

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Section: Specific Points For Setting Up Heart Failure Servicesmentioning

confidence: 99%

European Society of Cardiology Heart Failure Association Standards for delivering heart failure care

McDonagh

Blue

Clark

et al. 2011

European J of Heart Fail

232

198

View full text Add to dashboard Cite

show abstract

“…Whilst still not optimal (Komajda et al, 2005) guideline adherence has been found to improve when care is directed by heart failure specialists resulting in reduced inappropriate, omitted or incorrectly dosed medications (Ledwidge et al, 2004) and one way to improve adherence might be the quick up-titration of medicines by specialist nurses before discharge (Ryder et al, 2003). The improved application of guidelines by heart failure specialists has also been demonstrated for beta blockade (Mariani et al, 2008).…”

Section: Influence Of Polypharmacy On Clinician Prescribingmentioning

confidence: 99%

Polypharmacy in heart failure: A growing challenge

Rushton

Kadam

2011

British Journal of Cardiac Nursing

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Current guidelines in Heart failure recommend 'add on' prescribing of evidence based medicines aimed at improving symptoms and prognosis. Heart failure patients therefore commonly receive multiple drug therapies and this 'polypharmacy' is set to increase with the recognition of new potential drug targets. Drug regimes in heart failure are further complicated by increasing age and high levels of comorbidity inherent in this patient group. Nurses are central to the patient's care pathway and the commencement and titration of medicines are a key component of the patient's management plan. The development of nursing specialism in heart failure alongside independent prescribing have further extended nurse's responsibilities.Polypharmacy is an important consideration for nursing and this paper will provide an overview of the development of drug therapies in heart failure as well as the scope of polypharmacy for this group. The key implications of polypharmacy in heart failure will be explored which include side effects, drug interactions, prescription errors, optimal clinical prescribing and patient adherence.

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“…Two recent studies on follow-up found that patients declined study participation due to the risk of being assigned follow-up at primary care [ 12 , 33 ]. However, these days, when the competence of primary care has been enhanced with HF nurses and the quality of the care can be ensured [ 34 , 35 ], it would be advantageous and cost-effective to refer stable HF patients who are on optimal dosing of medicines to the primary care, which complies with the guidelines from ESC [ 2 ]. Furthermore, guideline adherence and patient adherence to medication have been found to be maintained when follow-up is managed within primary care [ 12 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

Continuity and utilization of health and community care in elderly patients with heart failure before and after hospitalization

2018

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BackgroundThe period after hospitalization due to deteriorated heart failure (HF) is characterized as a time of high generalized risk. The transition from hospital to home is often problematic due to insufficient coordination of care, leading to a fragmentation of care rather than a seamless continuum of care. The aim was to describe health and community care utilization prior to and 30 days after hospitalization, and the continuity of care in patients hospitalized due to de novo or deteriorated HF from the patients’ perspective and from a medical chart review.MethodsThis was a cross-sectional study with consecutive inclusion of patients hospitalized at a county hospital in Sweden due to deteriorated HF during 2014. Data were collected by structured telephone interviews and medical chart review and analyzed with the Spearman’s rank correlation coefficient and Chi square. A P value of 0.05 was considered significant.ResultsA total of 121 patients were included in the study, mean age 82.5 (±6.8) and 49% were women. Half of the patients had not visited any health care facility during the month prior to the index hospital admission, and 79% of the patients visited the emergency room (ER) without a referral. Among these elderly patients, a total of 40% received assistance at home prior to hospitalization and 52% after discharge. A total of 86% received written discharge information, one third felt insecure after hospitalization and lacked knowledge of which health care provider to consult with and contact in the event of deterioration or complications. Health care utilization increased significantly after hospitalization.ConclusionMost patients had not visited any health care facility within 30 days before hospitalization. Health care utilization increased significantly after hospitalization. Flaws in the continuity of care were found; even though most patients received written information at discharge, one third of the patients lacked knowledge about which health care provider to contact in the event of deterioration and felt insecure at home after discharge.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0861-9) contains supplementary material, which is available to authorized users.

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Implementation of Beta-Blockade in Elderly Heart Failure Patients: Role of the Nurse Specialist

Abstract: Although older age is associated with non-prescription of BB, BB can be implemented in an outpatient HF clinic with nurse specialist support even in elderly patients. although lower doses are achieved than in younger subjects.

Cited by 10 publications

References 34 publications

European Society of Cardiology Heart Failure Association Standards for delivering heart failure care

European Society of Cardiology Heart Failure Association Standards for delivering heart failure care

Polypharmacy in heart failure: A growing challenge

Continuity and utilization of health and community care in elderly patients with heart failure before and after hospitalization

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