Heart failure is common, costly and progressively life limiting. It is estimated to affect about 90,000 people in Ireland and approximately another 160,000 people are living with impending heart failure. These numbers are on the rise due to our ageing population and increased survival following myocardial infarction. However, many people have asymptomatic left ventricular dysfunction, uncontrolled hypertension and diabetes. This, along with improved treatment for those with established heart failure, is leading to these people living for a longer time period.

Despite proven efficacy, heart failure therapy is under-prescribed and, as a consequence, the role of the heart failure nurse became notable during the 1990s when many studies showed a significant benefit in care to both the patient and the health care system using specially trained nurses as part of a structured disease management programme. These programmes have led to well documented reductions in hospital readmission and structured follow up care that focuses on the optimisation of therapy, out-patient follow up and education for self-care. Self-care in a heart failure context is commonly poor and vulnerable to challenges such as advancing age, cognitive decline, poor health literacy and low levels of social support. 

There are currently 66 heart failure nurses working in the HSE. Within this group there is one ANP, two candidate ANPs and 30 registered nurse prescribers. The majority of these nurses work in the acute setting with a few working in the community. A recent review of heart failure services showed that we now have over 11,200 patients attending our services.

Many heart failure centres operate with just one nurse specialist. This can be incredibly isolating in practice development terms as communication between our nurses was limited to attendances at educational meetings until 2018 when we set up a WhatsApp group. This group chat has facilitated an informal networking bond. Sharing of experience now flows easily among nurses, who can now seamlessly share knowledge, practical advice and recently published evidence. This is especially useful for those who don’t have another heart failure nurse in their service. This connectedness facilitates peer support, the sharing of ideas and promotes a solution-focused problem solving approach.

In March 2019, we formed the Irish Association of Heart Failure Nurses as a subgroup of the Irish Nurses Cardiovascular Association (INCA). Our inaugural committee comprises Norma Caples, president; Cathy Farrell, vice president; Tara Mannion, secretary; Mairead Lehane, treasurer and Sarah Fall, PRO. Sarah Fall established our Twitter (@IAHFNurses) and Facebook accounts where we post updates on heart failure care and aim to raise public awareness of the signs and symptoms of heart failure. We feel that it is important for every cardiology nurse to be part of their national association. The networking, sharing of knowledge and experience is invaluable to creating a uniform standardised care. Bursaries are available to help nurses further their education through college or attendance at cardiology conferences.

Members of the Irish Association of Heart Failure Nurses attending the Heart Failure Meeting in Athlone in May (click to enlarge)

The initial goal of this first committee was to establish the association and share education among heart failure nurses nationally, promote the work of our nurses with the aim of achieving cohesive and equitable services for all our patients. Our next goal is to support the travel of some of our heart failure nurses to the European Heart Failure Congress 2020 in Barcelona. What better way to keep our knowledge and skills at the cutting edge of European and international best practice than to experience it first hand by interacting with the primary investigators and authors? This opportunity to update the group on new developments will also benefit practice development opportunities locally.

Our group is committed to improving services for our patients and we showed this enthusiasm when we commenced our first national project in 2018. The project focused on auditing the practice of treating heat failure patients with intravenous iron as per the 2016 ESC guidelines on heart failure. Our aim was to submit a poster presentation at the Heart Failure Congress in Athens 2019. We surpassed this aim when ours was chosen for ‘moderated poster’. Michelle Carey from Tallaght University Hospital did us proud with the presentation of our work. We plan to use the results to work on improving this area for our heart failure patients.

We are currently working with the team for the National Clinical Programme for Heart Failure on developing educational resources for nurses about the management of heart failure patients. Combining the collective knowledge, skills and experiences of 66 heart failure experts should prove an engaging resource. 

Current updating of the heart failure model of care is timely as we brace ourselves for a substantial health service challenge and embrace the principles of Sláintecare in making care as patient-centred as possible.