Nurse navigation dates back to the 1990’s when a program was launched to save lives from cancer by decreasing barriers to care

Common barriers experienced by patients include: lack of insurance, lack of information, lack of trust in the medical system

Nurse Navigators competencies outline the knowledge, skills, and expertise to effectively assist patients navigate the healthcare system

Assessing health and financial literacy and work with the patient within those limits is key to successfully coordinate care within the health system

Effective communication includes active listening, verbal and written skills

Educating and reinforcing prior education on understanding diagnosis, recognizing potential symptoms, and self-care strategies should be included in patient education tools

Nurse navigators should develop and/or participate in quality improvement projects as part of their professional role

From novice to expert, nurse navigators should continue to advance in their utilization of HF core competencies

Professional organizations that serve as resources to the HF nurse navigation include AAHFN, HFSA, ACC, PCNA, AHA, HRS

Community Health Nurses use a Holistic approach to help Heart failure patients. Their team may include HF RN, OT, PT, SW, SLP, Diabetes RNs, Dietitians, Telehealth, Hospitalization Preventative Calls

Social Determinants of Health include health literacy, transitions of care, financial barriers, food insecurities, transportation, mobility, lack of caregiver support, socioeconomic issues

Health literacy may be influenced by: ability to read/write, understand/apply math, ability to use technology, vision/hearing, language, mental health, cognition, education level

The majority of nurses underestimate the rates of low health literacy in the general public, as they make their assessment based on interactions rather than objective screening tools

Low Socioeconomic status (SES) patients are more likely to have a hospital readmission than those patients with higher SES

As patients become more fragile, demands to meet their needs increase - Caregiver burden & burnout in caring for chronically ill individual: Multiple MD appts, Hospitalizations/ER visits, financial difficulties, medication management

Strategies for success: Increased focus on patients in lower SES areas, focus on symptom management, dietary education/utilization of food bank, med management, remote monitoring, interprofessional home visits, community based palliative care NP

The 2 most commonly HRQoL assessment tools used in Heart Failure include the Kansas City Cardiomyopathy Questionnaire (KCCQ) and Minnesota Living with Heart Failure Questionnaire

Difficult discussions should occur early and often throughout the trajectory of a HF patient particularly when considering procedures (PPM/ICD/Ablations), medication changes (intolerance/cost), need for additional therapies (iHD) or adv therapies (LVAD/Transplant), symptom burden, caregiver needs (ability to drive), and/or quality of life.

Shared decision making involves clinicians working with patients to ensure that patient’s values, goals, and preferences guide informed decisions that are right for each individual patient

Decision aids should use plain language, avoid bias, and provide balanced information on risks and benefits. They should be used to complement rather than replace conversations with the healthcare team

Steps to motivate patients include developing shared goals and negotiating to make changes in small steps, while praising their achievements.

Support groups offer an opportunity for people to talk about personal experiences and feelings, and fills a gap between medical treatment and the need for emotional support

First step on a quality improvement project is to identify a problem or an opportunity for improvement

Select an improvement Framework i.e. Plan, Do, Study, Act

PLAN: Review literature for standards on care, recommended guidelines for disease management, strategies implemented in other areas that could be translated into the QI project and metrics that could be used to evaluate project’s success

DO: Create a team of experts that could collaborate in the project and develop a strategy to address the identified problem. Then, implement the intervention at small scale

STUDY: Observe and Measure success of the intervention. Determine what worked and what did not. Address issues that may be hindering success

ACT: Re-implement strategy with changes based on what was learned in prior stage. Disseminate knowledge or expand scope of the intervention if successful

Lifestyle factors, Predisposing factors, socioeconomic factors and healthcare context all contribute to HF incidents.

Prevention of HF focuses on Stage A HF patients (HTN, Atherosclerosis, DM, obesity, metabolic syndrome, use of cardio toxic agents or family history of cardiomyopathy)

Tools can be used to predict risk for developing HF. (age, race, sex, prevalent CHD, DM, systolic BP, BP medication use, smoking and BMI)

We can prevent HF buy watching out for high-risk patients, meticulous BP management, encourage exercise and choosing the correct medications for diabetes

Diabetic Women have a significantly higher risk of developing HF.

Low health literacy is more prevalent among older adults, minority populations and low socioeconomic status

There are similar risk factors for Afib and Heart Failure including HTN, obesity, DM CAD, CKD, alcohol use and smoking.

Afib risk reduction includes weight loss, physical activity, HTN management, alcohol cession and sleep apnea management.

Tikosyn, Amiodarone and Sotolol are used for afib in patients with HFrEF. Flecainide and multaq are avoided.

Catheter ablations may be more effective in controlling afib than medications and help to prevent worsening HF.

Heart Failure is defined as having HF symptoms caused by a structural and/or functional cardiac abnormality, corroborated by objective evidence of cardio-pulmonary systemic congestion or elevated NT-proBNP levels

Patients need to be assessed for current signs and symptoms including adherence to prescribed treatment plans such as medications, nutrition, and fluid restrictions

Shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, edema, chest pain, and abdominal discomfort including poor appetite are common symptoms of heart failure

The use of mnemonics can help to gain insight into a patient’s presentation such as PQRST (precipitating factors, quality, radiations, severity, and timing)

A rapid assessment of hemodynamic status includes evidence of congestion and/or low perfusion

An elevated Brain Natriuretic Peptide (BNP) correlates with excess intravascular volume and helps determine the cardiac cause of dyspnea

2D echocardiogram views the heart structure, and function, and assesses the flow of blood through the heart chambers and valves

HFpEF is present when LVEF is >/= 50%, signs of congestion, elevated proBNP AND other conditions are excluded (i.e. infiltrative, pericardial, valvular heart disease, etc)

HFpEF results from changes to the myocardial cells over time caused by the contribution of other conditions (increasing age, HTN, DM, AF, obesity, OSA, COPD)

HFpEF represents >50% of cases of overall HF and most HFpEF patients are women

Prevention is the KEY to reducing HF progression. Focus on strategies to reduce the risk for HF and control current co-morbid disease prevention

Education strategies should include disease-specific education, medication management, life style modifications, and potential implications of non-adherence

HFpEF management is focused on managing comorbidities such as HTN, DM2, CAD, AF, CKD, Obesity, Sleep Apnea

GDMT for HFpEF include SGLT2i, Loop diuretics, MRA, ARNI/ ARBs

Nonpharmacological Management includes weight loss, exercise, and pulmonary artery pressure monitoring

There are multiple specialists that will need to be included in the management of HFpEF including PCP, cardiologist, HF specialist

Diuretic resistance, HF medication intolerance and repeated hospitalizations may be indicative of end-stage heart failure

PC reduce symptom burden and improves HRQoL & decreases the cost of healthcare

Dyspnea, Fatigue and hypotension are the most common HF s/s at the EOL

GDMT may need to be deprescribed at the EOL to reduce HF symptoms

Early interventions at home reduces hospitalizations - Mobile applications provide PC education including emergency contacts, power of attorney, and symptoms that may be managed by PC services

Turning off ICD based on patient’s or families at the EOL is not illegal and is NOT considered physician assisted suicide

Timing of Device Therapy Discussion – make ICD therapy suspension part of the GOC discussion when hospice and comfort care are being considered