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Heart failure and End of life workstreams

What is heart failure?

Heart failure is a clinical syndrome in which the heart's ability to pump is compromised and is characterised by symptoms such as breathlessness and fatigue, and signs such as fluid retention. People with chronic heart failure typically experience a poor quality of life and survival rates are worse than for breast and prostate cancer.

The financial costs are also high, accounting for 2 per cent of healthcare costs through frequent community and hospital contact. Prevalence is predicted to rise over the next 20 years, and health services need to develop integrated services to manage heart failure services.

ICD deactivation guidelines

The Network has published its Guidelines for deactivating implantable cardioverter defibrillators (ICDs) in people nearing the end of their life (January 2013). Deactivating an ICD means 'turning off' the shocking function of the defibrillator so that a patient is not unnecessarily 'shocked' in the last minutes of life. The ICD will continue to provide bradycardia (slow heart rhythm) support should the patient need it but will no longer provide lifesaving therapy in the event of a ventricular tachyarrhythmia.

2011 Heart failure commissioning guide

Heart failure (HF) is one of the most common medical conditions affecting almost a million people in the UK, accounting for 2 per cent of the entire NHS budget. This is an area where better healthcare can be delivered at less cost, leading to improved health outcomes.

SLCSN documents

GP Heart Failure Algorithm for commissioners - diagnosis

GP Heart Failure Algorithm for GPs - diagnosis

Guidelines for symptom control and specialist palliative care referral for adult patients with end-stage heart failure

National priority projects

Working with the BHF to improve cardiac delivery services

In response to the development of the National Service Framework Chapter Eight, the British Heart Foundation (BHF) awarded funding in May 2008 for 32 clinical nurse specialists over three years to improve arrhythmia delivery services across England and Wales.

Through its relationship with the BHF, the SLCSN worked to secure funding for 10 of these arrhythmia specialist practitioners (ASP) in organisations across South London.

The ASPs were charged with streamlining care across primary, secondary and tertiary care with the support of the SLCSN, providing arrhythmia patients with appropriate treatment and top quality care throughout the entire patient pathway.

We achieved improved quality outcomes in arrhythmia care across South London through the BHF's financial assistance, the SLCSN's comprehensive support and the expertise of the ASPs.

BHF's heart failure nurse services in England:
Executive summary

The development and impact of the BHF and Big Lottery Fund heart failure specialist nurse services in England:
Final report April 2008


NHS Southwark: Uncovering discrepencies within heart failure

A review of heart failure cases between primary care and GP practices revealed a substantial difference between the expected prevalence and the recorded prevalence data.

The project in NHS Southwark sought to understand the cause. The team set to work comparing heart failure patients in hospital admissions data to that in GP practices. They found that certain international classification of disease (ICD) codes were not included across the patient pathway.

The team also examined discharge summaries and learned there was a lack of consistency there, too.

The discoveries from this project generated a similar investigation at NHS Bromley, and the team believes that the evidence gathered will be similarly substantial. In examining processes both upstream and downstream, the SLCSN can work with clinicians within organisations to make prudent, though dramatic, changes in procedure that improves our ability to find the patients who need our care the most.

Heart failure is more common than most cancers, including breast, testicular, cervical and bowel cancers.

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National priority projects: Heart failure

The gold standards framework

Heart failure

National heart failure audit (2008)

Heart rhythm devices national report (2008)

Pushing the boundaries: Improving services for patients with heart failure (2007)

Guidelines for management of hypertension: British Hypertension Society (2004)

NICE chronic heart failure guidance (2003)

End of life

Department of Health's End of life strategy (2008) and First annual report (2009)

King's Fund: Delivering better care at end of life (2009)