The Community Heart Failure Nurse Service (CHFNS) comprises of a team of specialist nurses skilled in the management of patients with heart failure.

The service offers:

• heart failure management in the community to prevent admission/re-admission
• patient reviews within two weeks after discharge from hospital following a heart failure admission
• a mix of clinics (see Locations), home visits and telephone consultations based on patient need
• titrate medication to ensure patients are on maximum tolerated doses of evidence-based medications (NICE 2018/ESC 2021)
• support with end-of-life care for heart failure patients
• patient/families/carers education to assist with self-management
• referrals back to the GP for routine care once the patient is stabilised.

This service operates Monday to Friday, 9am-5pm. The team is offered clinical support and guidance by local cardiologists at Whittington Health (WH), University College London Hospital (UCLH) and North Middlesex University Hospital (NMUH).

Eligibility Criteria

Inclusions

• aged 18+ and registered with a GP in Islington or Haringey
• Confirmed diagnosis of heart failure with HFrEF, HFmEF and HFpEF; the diagnosis must be confirmed by an echocardiogram and the patient must have been seen by a cardiologist or a physician with a specialist interest in heart failure in line with NICE guidelines (this information must be provided on referral to the CHFNS)-
  The CHFNS will accept patients with heart failure with normal left ventricular ejection fraction (HFpEF) with a clear management plan completed by the named cardiologist on referral and with the following criteria only:
  • normal left ventricular ejection fraction (LVEF 50% or more on echocardiography) with moderate or severe left ventricular diastolic dysfunction and dilated left atrium (LAVI >38 ml/m2) and/or left ventricular hypertrophy (indexed LV mass >110 g/m2 for men and >99 g/m2 for women), or
  • normal left ventricular ejection fraction (LVEF 50% or more on echocardiography) with severe valvular dysfunction.
• newly diagnosed or unstable confirmed heart failure commencing on/or support with medication/treatment optimisation
• patients requiring specialist education, advice, information and support at any stage in their disease pathway from diagnosis through to palliative care stages
• end stage heart failure.

Exclusions

• Patients aged under 18
• Echo not available (all referrals without an available echo will be appropriately signposted and followed up with GP or cardiology team as required)
• Patients will not be accepted within six weeks of myocardial infarction, coronary artery bypass graft surgery, percutaneous coronary intervention and/or valve surgery, and will require repeat echocardiogram to reassess left ventricle function to confirm chronic heart failure by the referrer
• Acute myocardial infarction within six weeks of referral with subsequent heart failure
• Patients requiring hospital transfer for cardiology intervention
• Patients who refuse to receive care from the team 
• Pregnant patients
• Normal LV function with end-stage renal disease CKD 4 0r 5 with eGFR ≤ 15/ patients on dialysis.
• Patients awaiting valve surgery (AVR/MVR).
• Patients echoed in atrial arrhythmias with heart rate exceeding 100bpm require rate control and re-echo before referral.
• Immediately post MI: must have echo six weeks post MI
• Patients with COPD and Cor pulmonale (advice may be offered to respiratory team for management of diuretics)
• Normal LVEF with primarily pulmonary hypertension (under care of pulmonary hypertension team at RFH Trust)
• HFpEF patients that are not on a medium-dose loop diuretic (80mg Furosemide or Bumetanide equivalent) and with no recent HF admission
• Patients registered with a GP outside NCL
• Other immediately life-threatening illness, for example, advanced malignancy
• Aggressive/abusive behaviour
• Non adherence with mental capacity
• DNA two consecutive appointments or cancel two in under 24 hours consecutively
• HFPEF with no management plan from cardiologist
• CKD IV at discretion of cardiologist and renal team (eGFR15-30)
• Patients with significant valve disease awaiting surgery
• Stable symptoms and medications optimised. 

How to Refer

Locations

Hornsey Rise Health Centre

Hornsey Central Neighbourhood Health Centre

Lordship Lane Primary Care Centre

River Place Health Centre