A dummy guide to successful heart failure reviews

Background

As a pharmacist, you will see many patients with heart failure. Under QOF, the indicator HF007 relates to the percentage of patients with heart failure who have had annual review including functional capacity and medication review to ensure that their medicines are at maximum tolerated doses. This guide aims to help you complete successful heart failure reviews.

Other relevant indicators

There are four other heart failure indicators: HF001 (protected), HF008, HF003 and HF006; the latter two of which measure the percentages of patients on ACEis/ARBs or beta blockers. Successful heart failure reviews are vital for effectively managing heart failure patients, optimizing their treatment, and improving their quality of life. The following is our dummy guide on how to conduct such reviews:

1. Appointment Scheduling:
   • Contact the patient to schedule a heart failure review appointment. Reviews should occur regularly, ideally every 6 to 12 months, depending on the patient’s clinical stability and individual needs.
2. Preparation:
   • Gather the patient’s medical history, including previous heart failure assessments, test results (e.g., echocardiogram, electrocardiogram), medication list, symptom diary (if available), and any recent hospital admissions related to heart failure.
3. Patient Assessment:
   • Begin the review by assessing the patient’s current heart failure symptoms and their impact on daily activities and quality of life. Inquire about and check symptoms such as dyspnea, fatigue, orthopnoea, paroxysmal nocturnal dyspnea, peripheral oedema, and exercise tolerance.
   • Evaluate any changes in symptoms since the last review, including exacerbations or worsening of heart failure symptoms.
4. Medication Review:
   • Review the patient’s current heart failure medications, including angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin receptor blockers (ARBs), beta-blockers, mineralocorticoid receptor antagonists (MRAs), diuretics, and ivabradine if prescribed.
   • Ensure the patient is adhering to their medication regimen and discuss any difficulties or concerns they may have.
   • Consider adjustments to the medication regimen based on the patient’s symptoms, clinical status, and guideline-directed medical therapy.
5. Assessment of Clinical Stability and Functional Status:
   • Evaluate the patient’s clinical stability and functional status using validated assessment tools such as the New York Heart Association (NYHA) functional classification or the Kansas City Cardiomyopathy Questionnaire (KCCQ).
   • Discuss the results of the clinical stability and functional status assessment with the patient and explain their implications for treatment optimization.
6. Review of Lifestyle Factors:
   • Discuss lifestyle factors that can impact heart failure management, including diet, fluid intake, sodium restriction, physical activity, smoking cessation, and alcohol consumption.
   • Provide education and support to help the patient adopt heart-healthy lifestyle behaviors and manage comorbid conditions such as hypertension and diabetes.
7. Fluid Management:
   • Assess the patient’s fluid status through clinical examination, including monitoring of weight, fluid intake, and symptoms of fluid retention.
   • Adjust diuretic therapy as needed to maintain euvolemia and prevent volume overload or dehydration.
8. Education and Self-Management:
   • Provide heart failure education tailored to the patient’s needs, including information on medication adherence, symptom recognition, dietary recommendations, and when to seek medical assistance.
   • Empower the patient to monitor their symptoms, adhere to treatment recommendations, and actively participate in managing their heart failure.
9. Referral and Follow-Up:
   • Consider referral to specialist heart failure services or cardiology for patients with complex or advanced heart failure, including those requiring device therapy or consideration for heart transplantation.
   • Schedule a follow-up appointment based on the patient’s clinical stability, medication changes, and individual needs.
10. Documentation and Communication:
    • Document the findings of the heart failure review, including symptom assessment, medication review, functional status assessment, education provided, and any referrals or follow-up plans, in the patient’s medical record.
    • Share any significant findings and treatment recommendations with the GP, community heart failure nurses or secondary care to ensure coordinated management.

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