Characteristics and outcomes of patients with heart failure with preserved ejection fraction referred to a community specialist nurse-led clinic

Abstract

Background/Aims Heart failure with preserved ejection fraction remains relatively poorly understood, despite its increasing prevalence. It is unclear how most clinical services are adapting to changes in caseload and management. This study aimed to describe the characteristics and outcomes of patients with heart failure with preserved ejection fraction who were referred to a community heart failure specialist nurse-led clinic, and to evaluate the clinical interventions implemented during patients’ reviews. Methods A longitudinal cohort design was used. Baseline characteristics and 6-month data on heart failure specialist nurse interventions, morbidity and mortality were collected for all patients (n=80) referred and allocated to the community heart failure specialist nurse-led clinic between November 2022 and June 2023. Data were collected from the service's electronic medical record system and analysed with descriptive statistics using SPSS version 28. Results A total of 696 referrals were made of patients with confirmed or suspected heart failure, of whom 80 were allocated to heart failure specialist nurse caseloads. The mean age of the sample was 82 years (±8.85 years), with each patient having a median of three comorbidities. At the end of 6-month period, 37.5% were discharged and 38.8% were on a patient-initiated follow-up pathway, with a median of four contacts. Interventions received at the specialist clinic included management of comorbid conditions. Prescribing focused on diuretic titration and sodium-glucose cotransporter-2 inhibitors initiation. Of the 65 hospital admissions recorded, 45 (69.2%) were unrelated to heart failure, while 20 (30.8%) were related to heart failure. Conclusions The community heart failure specialist nurse-led clinic resulted in the initiation or adjustment of key therapies in heart failure with preserved ejection fraction. Heart failure specialist nurses can autonomously implement advanced interventions in heart failure with preserved ejection fraction, despite patients’ complexity. Some aspects of care require improvement, such as comprehensive geriatric assessments, multimorbidity management and involvement of cardiac rehabilitation and palliative care teams.