Heart Failure Programs Europe and Belgium Sandra Martin

Heart Failure Programs Europe and Belgium Sandra Martin Clinical Nurse Specialist UZ Leuven, Belgium

ESC guidelines “an organized system of specialist heart failure care should be established to improve the outcome of patients with heart failure (class 1 A)” Ø “depending on the local health care systems, it seems important to determine which health care provider is the most appropriate to participate in various components” Ø “nurses and other health care providers can play an important role in these innovative forms of care” Ø Swedberg K et al. , Eur Heart J. 2005; 26: 1115 – 40.

HF in Europe Ø 20 years ago Sweden established the first type of HF programs in Europe Ø Stimulate the development of HF programs in Europe Ø What is the current situation in Europe? Ø Study: 2003 - 2005 l To identify the number and content of HF programs in Europe Jaarsma T et al. , Eur J Cardiovasc Nurs. 2006 Sep; 5(3): 197 -205.

HF in Europe Ø Research questions: l l l 1. Which European countries have established HF management programs and in what proportion relative to the number of hospitals? 2. What are the characteristics of the HF management programs (e. g. referral system, personnel, setting, and funding)? 3. What is the specific content of these HF management programs? Jaarsma T et al. , Eur J Cardiovasc Nurs. 2006 Sep; 5(3): 197 -205.

HF in Europe BELGIUM < 30 % HF PROGRAMS ? ? ?

HF in Belgium Ø A total of 139 hospitals were invited to fill in the questionnaire (email – regular mail) l l l l Cardiologist specialized in HF Head of cardiology Head of internal medicine Heart failure nurses University Hospitals Regional Hospitals with extended cardiology facilities Regional Hospitals

HF in Belgium A program delivering coordinated and comprehensive treatment and care specifically targeted at HF patients, such as a HF outpatient clinic, a HF home program or a HF multidisciplinary team. A total of 35 (25. 2%) responded to the questionnaire Ø Of which 18 (12. 9%) had a HF management program (Non-responding hospitals were categorized as no HF Ø program) Ø 5 plan to start a HF program

Setting Ø In-hospital and outpatient clinic: 13 Ø Outpatient clinic: 4 Ø Combined hospital and home-based: 1

Follow up Ø Follow up after hospitalization and/or HF control: l l l Cardiologist: 6 HF nurse: 0 Cardiologist and HF nurse: 12 Ø Palliative care: 5 Ø Home visit: 2

Referrals Ø Hospitalization unit: 11 Ø Cardiologist: 16 Ø Internist/geriatrician: 2 Ø Primary care physician: 13 Ø Home care: 2 Ø Patients themselves: 3

Content HF program Patient education Patient initiated telephone consultation Medical changes (protocol) by nurse Physical examination by nurse Education of other health care providers Coordination of care Nurse-initiated telephone follow up Psychosocial interventions Exercise training Behavioral interventions 18 15 5 15 7 11 11 13 14 15

Patient education Ø Verbal and written information: 18 Ø Group information: 6 Ø Computer based education: 3 Ø Educational video: 0 Ø Family education: 14

Nurse education/training Ø Nurse assistant (A 2) : 3 Ø Bachelor (A 1) degree: 16 Ø Masters degree: 3 Ø In-service training: 13 Ø HF courses: 12 Ø Extensive cardiac care experience: 12

Funding Ø Hospital: 14 Ø Department of Cardiology: 12 Ø Home care: 0 Ø National health care system: 3 Ø Pharmaceutical companies: 0

Multidisciplinary team Ø Regular meetings: 9 Ø Ø Ø Ø Cardiologist: 18 Nurse: 16 General practitioner: 12 Social worker: 12 Psychologist: 13 Physiotherapist: 11 Dietician: 12 Primary care nurse: 4

Evaluation of care/research Ø Clinical trials: 12 Ø Quality of life: 5 Ø Readmission rate: 5 Ø Survival: 5 Ø Patient satisfaction: 4 Ø Tele-monitoring: 3

Discussion Ø Low response rate l l Reminder Fill in now at the symposium! Ø Large gap between the evidence and the application of HF programs (health care system) Ø No systematical evaluation of the service (outcomes)

Discussion Ø Need for academic nurse education/ core curriculum/ certification Ø Findings similar to Europe study: l l Less home care service Greater multidisciplinary involvement

Conclusion Ø Despite the evidence of specialized care for HF patients Ø Only 18 HF clinics exists in Belgium l l In and out of hospital care Multidisciplinary team: cardiologist/nurse Ø Need for more involvement of the primary care physician/nurse Ø HEALTH CARE SYSTEM CHANGE to increase the number of HF clinics

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