Nursing care and education in heart failure

The number of patients with heart failure has steadily increased during rec ent decades and the cost of frequent hospitalizations has had a strong econ omic impact on health care sen ices. The compliance and education in heart failure patients are poor, and only a small proportion of the patients are on optimal therapy. Therefore, it is justified to build up specific heart f ailure units. Eight years ago we started the first physician-nurse based ou tpatient heart failure clinic in Sweden, where the nurses after passing an examination in heart failure have special authority to handle this type of patient. The nurses may introduce and uptitrate the dose of ACE inhibitors and beta-receptor blocking drugs, perform an early follow-up of all patient discharged from hospital because of heart failure, perform close follow-up s in patients with severe heart failure, and inform and educate the patient s and their family members in self-care. We have also created a computer-ba sed information program to enhance the compliance in our patients. The numb er of patients hospitalized in our hospital has decreased during the last 5 years and patients discharged from the hospital because of heart failure a re mostly on treatment with ACE inhibitors (93 %), and whether this is due to the work by the people in the heart failure unit or not is under evaluat ion in an ongoing randomized study. We believe that this model with a physi cian-nurse based organization in the management of heart failure creates in creased safety and self-confidence in our patients and increase their motiv ation to follow prescribed medication and improve quality of life and preve nt the need for further hospitalization.