Heart failure clinics

Is there a need for outpatient heart failure clinics? During the past few decades, heart failure in industrialised countries has continuously increased, particularly in the elderly population,1 2 and the cost of frequent hospitalisations has had a strong economic impact on health services. In Scotland, the number of hospitalisations because of heart failure increased by almost 60% between 1980 and 1990.3 In the Netherlands, admissions with heart failure as principal discharge diagnosis rose 48% for men and 40% for women between 1980 and 1993.4 In this issue Michalsen and colleagues5 present the results of a study about preventable factors leading to hospitalisation in patients with decompensated heart failure. Non-compliance with prescribed medication and diet led to 42% of the admissions, while 12% were the result of inadequate medical treatment. In another study,6 Vinson et al stated that up to 50% of the readmissions could have been prevented; the preventable factors were non-compliance with medication or diet, inadequate discharge planning or follow up, poor social support, and failure to observe a worsening of symptoms. One way of providing optimal care and follow up is to set up outpatient clinics for patients with heart failure. The first nurse led outpatient heart failure clinic in Sweden opened in 1990 in Linkoping, and the model has now spread to many hospitals in Sweden and Norway. The clinic provides drug titration, structured follow up, and patient education. The aim is to improve the patient’s quality of life, compliance and self care, and to reduce morbidity and the need for hospital care. Nurses with special education and training in heart failure work independently in the clinics. They have the responsibility for making protocol led changes in medications, such as titrating …