Clinical education: Improving the management of heart failure in primary care

Over the past 12 months, a series of clinical heart failure education sessions have been held across NHS Bury and Wigan Borough CCGs, as part of the Greater Manchester Heart Failure Investigation Tool (GM-HFIT) programme.

This comprehensive programme of work aims to improve the quality of heart failure management in NHS primary care by improving detection and care. A key component of this is the provision of clinical education sessions which aim to up-skill primary care clinicians in the diagnosis, treatment and management of people with heart failure, enabling them to provide consistent high quality care for their patients and help their patients improve their own knowledge of, and ability to self-manage, their condition.

Local GPs, practice nurses and practice managers engaged in the project have taken part in a number of interactive workshop-style sessions, hosted by the CLAHRC for Greater Manchester, covering topics pertinent to the management of heart failure in primary care. Topics include heart failure diagnosis and aetiology, medication management and titration, patient monitoring and review, education and self-management, and palliative care. Within these sessions, GPs and practice nurses have also been provided with an opportunity to raise and discuss specific, and often complex, clinical cases from their own practices, strengthening their learning and enabling the education session to have an immediate and direct impact on patient care.

A series of smaller ‘in-house’ heart failure education sessions have also been held with individual GP practices, addressing areas that have been identified through the GM-HFIT programme as requiring development specifically at an individual practice level. Such areas have included clinical coding, use and titration of beta blocker therapies, and conducting regular heart failure reviews for patients as recommended by NICE guidelines.

Katy Rothwell, Knowledge Transfer Associate for the CLAHRC Greater Manchester, said: “The heart failure education sessions have provided an excellent opportunity for primary care clinicians involved in the GM-HFIT project to deepen their understanding of the diagnosis and management of heart failure. As our baseline audits have demonstrated, significant variation exists in the quality of heart failure management in primary care. Through these education sessions we aimed to ensure that all patients can benefit from high quality, evidence-based heart failure care.”

While the primary aim of the education has been to develop the knowledge and skills of those in attendance, the sessions have also provided a prime opportunity for GPs and practice nurses to develop closer working relationships with their local heart failure specialist nurses, who have delivered a number of presentations within each session. Anecdotal evidence suggests that this interaction has promoted collaborative working and led to significant improvements in the interface between primary, secondary and community care heart failure services.

Heart failure affects around 900,000 people in the UK and is particularly common among older people, with prevalence expected to increase over the next 20 years. Heart failure can be extremely debilitating, and there is evidence that people with this condition have a worse quality of life than those suffering from most other chronic conditions. As a result, heart failure impacts significantly on the availability of hospital beds and on the number of emergency admissions and re-admissions to hospital. Heart failure accounts for 2% of NHS inpatient days and 5% of all medical admissions to hospital, and it is the largest single reason for emergency bed days due to a chronic condition. Rates of re-admission are amongst the highest for common conditions in the UK.