Managing Patients With Heart Failure: A Qualitative Study of Multidisciplinary Teams With Specialist Heart Failure Nurses

Margaret Glogowska; Rosemary Simmonds; Sarah McLachlan; Helen Cramer; Tom Sanders; Rachel Johnson; Umesh T. Kadam; Daniel S. Lasserson; Sarah Purdy

doi:10.1370/afm.1845

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Table 1

Health Care Clinicians Who Took Part in the Interviews

Staff Based in Primary Care	Staff Based in Specialty Care	Staff Based in Community Care
Location 1 (South West)
Two separate hospitals provide outpatient heart failure clinics; community specialist heart failure nurses see patients with heart failure of any type, but their capacity is limited.
General practitioner (P1)	Cardiologist (P8)	Specialist heart failure nurse (P20)
General practitioner (P2)	Geriatrician (P9)
General practitioner (P3)	Hospital liaison psychiatrist (P10)	Community matron (P21)
General practitioner (interviewed twice) (P4)
Location 2 (South Central)
One hospital provides outpatient clinics with community specialist heart failure nurses seeing patients with left ventricular systolic dysfunction (LVSD) only.
General practitioner (P5)	Cardiologist (P11)	Specialist heart failure nurses (interviewed together) (P22 and 23)
General practitioner (P6)	Specialist heart failure nurses (interviewed together) (P12 and 13) Heart failure specialist nurse (P14) Cardiac Rehabilitation manager^a (P15)
Location 3 (Midlands)
One hospital-based rapid access ambulatory heart failure clinic with ongoing care in the community from specialist heart failure nurses seeing patients with heart failure of any type.
General practitioner (P7)	Cardiologist (P16) Specialist heart failure nurses) (interviewed together) (P17 and 18) Cardiac rehabilitation practitioner (P19)	Specialist heart failure nurse (P24)

P = participant.
↵a Cardiac rehabilitation is a structured set of services that can be offered to people with heart failure to provide physical and psychological help to preserve or resume their optimal functioning.

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The Article in Brief

Managing Patients With Heart Failure: A Qualitative Study of Multidisciplinary Teams With Specialist Heart Failure Nurses

Margaret Glogowska , and colleagues

Background Recognizing that management of patients with heart failure is uniquely challenging, researchers in the United Kingdom explored the perceptions and experiences of clinicians working in multidisciplinary teams that include specialist heart failure nurses whose serve as caseworkers. These experienced senior nurses become involved with patients at the initial diagnosis of heart failure and continue for the course of the patients' illness, offering medical, psychological, and emotional support.

What This Study Found The 24 clinicians interviewed identified two areas that represent particular challenges when working with heart failure patients: 1) communication with patients, in particular, explaining the diagnosis and helping patients understand the condition, and 2) communication within the care team to coordinate multidisciplinary involvement in managing patients' treatment regimens. All of the interviewed clinicians regarded specialist heart failure nurses as the lead clinicians for their patients, helping to ensure coordination, continuity, and quality of care. The nurses were perceived as being able to bridge the gap between primary and secondary care by ensuring recommendations from specialist physicians were acted upon and by taking the lead in medication issues so that prescribing decisions reflected input from secondary care providers.

Implications

These findings highlight the critical role of specialist heart failure nurses in delivering tailored education to patients and facilitating better liaison among clinicians to ensure better quality of care. According to the authors, the way in which these nurses serve as caseworkers is vital in ensuring coordination and continuity of care for heart failure patients.