Guidelines for the Care of Heart Failure Patients

A recent graduate student I was precepting asked me about existing guidelines and algorithms for caring for the patient with heart failure. I dutifully pulled out the ACCF/AHA guidelines, the Heart Failure Society of America (HFSA) guidelines, and the European Society of Cardiology (ESC) guidelines, along with their websites and pocket guides (and slide sets and PDA downloads….). We looked through them together and then he asked, “Well, where is the guideline information on the nursing care for these patients?”

Does anybody have a good answer for him?? I sure didn't. There is certainly some very important information in all of these guidelines about interventions we as nurses do for patients with heart failure, for example:

But all of these topics, and almost all other non-pharmacologic-non-device interventions reviewed in these guidelines are labeled as “Level of evidence C”, which means that the evidence comes from very limited populations and includes data from consensus opinion of experts, case studies, or standards of care, not from more rigorous randomized or non-randomized trials or meta-analyses.

This issue was further exemplified in the results of a survey of non-pharmacologic care by heart failure experts.4 Significant variability in practice was noted in the following areas: sodium-restricted diets, alcohol use, sexual activity, increased weight including use of a diuretic regimen, and palliative care. Providers also varied in their treatment of risk factors and comorbid illness, and in their beliefs about patient education and health literacy.

Thus we have limited evidence about many of the interventions we as nurses routinely do for patients, and the actual use of these interventions varies widely among even those providers who identify themselves as experts in the care of heart failure patients.

We owe our patients better than this. AAHFN recognizes the gaps in practice knowledge and will soon be surveying our membership about this and acting on it. Stay tuned.

Sue Wingate RN, PhD, CRNP

President, AAHFN