Implementation strategies to manage heart failure outcomes.
In the United States, chronic systolic heart failure causes a great economic burden. Pharmacologic and nonpharmacologic therapies must be tailored to the pathophysiologic cause with the ultimate goal of promoting regression or preventing progression of left ventricular remodeling. When this goal is met, symptoms are reduced, quality of life is improved, and morbidity and mortality are decreased. Specific objectives in a nurse-managed heart failure clinic are to improve exercise tolerance, decrease symptoms, and prevent or reduce emergency department visits and acute hospital admissions. Before a nurse-managed outpatient program for heart failure care is implemented, the team must address specific management issues and controversies in heart failure. Actions must focus on chronic disease management rather than just episodic care. Written protocols or algorithms provide guidance in pharmacologic and nonpharmacologic care and ensure that consensus guidelines that offer the best hope of reaching goals are followed.
Department of Advance Practice Nursing and Nursing Education and Research, Division of Nursing, Cleveland Clinic Foundation, Cleveland, Ohio, USA. albertn@ccf.org
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D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D002908:Chronic Disease; D006333:Heart Failure / Q000451:nursing* / Q000628:therapy; D006801:Humans; D009718:Nurse Administrators / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000458:organization & administration