“Heart failure is a big cause of hospital admissions and prolonged hospital stays”: Meet Clare Screeche-Powell

Clare Screeche-Powell, lead nurse for heart failure, discusses the main causes of heart failure and the importance of working collaboratively with colleagues, both inside and outside the Trust, to facilitate timely diagnosis of heart failure and improve patient outcomes.

What is your role at the Trust and how long have you been at the Trust?

I am the lead nurse for heart failure at the Trust. My role covers each of our three acute sites, as well as the community. I have been at the Trust since 2010. It has been really rewarding and challenging (in a good way!) so far.

What I love most about my role is the complexity of the patients we manage – both in our hospitals and in the community. The majority of patients we manage have multiple long-term conditions including heart failure. Our role is it educate patients and their families about their condition and to ensure they are on the best evidence based therapies for them, at the best doses for them. We work closely with primary care to ensure this happens. This in turn makes patients less likely to be admitted (or readmitted) to hospital and to live a more symptom free life for longer.

I enjoy the variety of my role. We cover both inpatient and outpatient care as well as reviewing patients in their own homes. We provide education and support to facilitate self-management, and we refer to other services, such as cardiac rehabilitation and palliative care. The mainstay of treatment for heart failure patients is medical therapy. As nurses we are very well placed to monitor the effects of any medication changes we initiate. As a team we can also refer patients for more specialist heart failure therapies, including pacemakers and defibrillators and even for heart transplant assessment.

What does a typical working day look like for you?

As lead nurse for heart failure my role is slightly different to the rest of my team but a typical day for a heart failure nurse specialist will involve a morning ward round, clinic preparation, taking phone calls from patients and other health care professionals, triaging community heart failure referrals and responding to remote heart failure monitoring alerts. Another day may involve a specialist heart failure clinic and home visits.

What are some of the main contributors to heart failure?

Heart failure has many causes but can be the end stage of a number of different cardiac conditions. Heart disease and heart attacks, for example, can ultimately lead to heart failure. In this case, the main risk factors for heart disease are high blood pressure, high cholesterol, obesity and a lack of exercise or physical activity, so there is lots that can be done to prevent heart failure developing in this way.

Heart failure can affect anyone, it is a big killer, and a big cause of hospital admissions and prolonged hospital stays. We need to get better at identifying and managing heart failure in our patients. Some forms of heart failure are preventable by managing risk factors, but otherwise early diagnosis and treatment can slow the progression of the disease.

It is important that our team work with colleagues, both within primary and secondary care, to facilitate timely diagnosis of heart failure. The main symptoms of heart failure are shortness of breath, including waking up in the night short of breath and shortness of breath lying flat, swelling and fatigue. In the first instance, these patients will need a blood test to determine whether any further investigations are needed.

Have there been any exciting developments or break-throughs in your area in recent years?

Heart failure is primarily treated by medical therapy. There are two main types of heart failure: heart failure with reduced ejection fraction (when the heart muscle does not contract effectively, and less oxygen-rich blood is pumped out to the body) and heart failure with preserved ejection fraction (occurs when the heart muscle is stiff and cannot relax properly, causing high pressure inside the heart). Previously our treatment options for patients with heart failure with preserved ejection fraction was largely limited to symptom control with diuretic therapy but more recently there is evidence for additional medical therapies for these patients.*

Our heart failure remote monitoring programme has been up and running for some time now. We are continuing to develop this. The team has had the opportunity to present this work outside the Trust as well as having their work published.

Other recent developments for managing heart failure patients within Imperial include the introduction of the ‘Heart Failure Virtual Ward’. This was initially set up to speed up hospital discharge for heart failure patients. Traditionally patients have been kept in hospital for monitoring when they are first switched from intravenous diuretics (administered into a vein or veins) to oral diuretics. We can now send patients home as soon as they are switched from intravenous diuretics. They are then remotely monitored at home during the early hospital discharge period, but still have access to our heart failure service if issues are picked up during the remote monitoring period. I am excited to see how we can develop our virtual wards to avoid heart failure patients having to come into our hospitals in the first place.

*A diuretic is a substance that promotes increased production of urine, which in turn clears extra fluid out and brings down blood pressure.