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Research and Clinical Nurses support new strategy for discharge management of heart failure

Thursday 2 March 2017 1:37pm

One New Zealander dies every 90 minutes from coronary heart disease, according to Heart Foundation statistics, but researchers at The Christchurch Heart Institute (CHI) and Christchurch Hospital clinicians and nurses are working to turn this around.

Professor Richard Troughton, a Consultant Cardiologist and Researcher with the CHI, a University of Otago Research Centre based at Christchurch Hospital, is behind a plan that looks at reducing the likelihood of people with heart failure needing readmission to hospital for further heart failure events.

“We are testing a strategy for the discharge management of heart failure using knowledge gained from studies of the heart hormone, NT-proBNP, as an indicator of risk of worsening heart failure and the need for further treatment. This five year study which began in 2014, called IMPERATIVE-HF, will assist to identify when people are best ready for discharge from hospital as well as guide what medication is most effective to reduce further health problems,” he said.

Keeping Tabs on Patients

Research nurses, Carol Groves and Ruth Jardine liaise with the Emergency Department, recruiting people presenting to hospital with shortness of breath. If the cause is found to be due to heart failure these patients are offered participation in the IMPERATIVE-HF study where they will be randomly assigned to either, Usual Care and management within the existing heart failure services according to current guidelines, or follow-up care in the research clinic where medication is adjusted according to NT-proBNP levels.

CHI Research Nurse, Stephanie Rose, runs the research clinic while working closely with Heart Failure Clinical Nurse Specialist, Jo Scott, identifying and screening patients on the ward, overseen by Dr Samantha (Sam) Bailey and Professor Troughton.

“The IMPERATIVE-HF trial (Intensified Management using Peri-discharge Biomarker Testing and InterVention in acute Heart Failure), is a first of its kind randomised patient management study, involving clinical care supported by research outcomes,” said Stephanie, “The necessity for a high degree of liaison and interaction between the clinical and research areas, with Jo and myself as the main conduit for that, has opened and maintains communication across the teams.”

Jo, who along with Heart Failure Clinical Nurse Specialists Emma Reeves and Julie Chirnside, run Usual Care heart function clinics to monitor, assess and titrate heart failure patients. This is part of Christchurch Hospital’s Cardio Respiratory Integrated Specialist Services (CRISS) team.

Improved Patient Outcomes

Jo is responsible for liaising between Usual Care and the research team ensuring continuity of care, education and support of patients in the IMPERATIVE-HF research study group. In this way, study participants can be seen in one clinic without the need to attend a research clinic and a heart failure clinic.

“Working so closely with the CHI and Stephanie, in particular, has given me a better understanding of the role of research and an appreciation of the importance of the research process in the picture of medical care, leading to developing new practices, “ said Jo.

Stephanie agrees, “Mutual respect and professionalism, clear communication and importantly, listening to the needs of each area and responding to that, are key to why the relationship between research and clinical teams is working so well for us and, therefore, the patients. This includes highlighting where improvements in medical care can be made and providing insight into new avenues of research.”
Professor Mark Richards, Director of the CHI is pleased with the progress of the IMPERATIVE-HF trial and the collaboration that has been forged between the clinical and research teams.

“We look forward to continuing and progressing the excellent results of this alliance culture that binds our teams across all of our research and trials. This approach has been a natural part of the CHI’s work for many years now at Christchurch Hospital. The way we work overall is quite unusual compared with groups in other countries and perhaps in New Zealand. We are proud to be creating productive and affective results, feeding down to the patients who receive the medical care - the whole point of our existence,” he said.