Examining the clinical role and educational preparation of heart failure nurses across Europe. A survey of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) and the Association of Cardiovascular Nursing and Allied Professions (ACNAP) of the ESC

Abstract

Aims: To describe the clinical practice and educational preparation of heart failure (HF) nurses across Europe and determine the key differences between countries.

Methods and results: A survey tool was developed, in English, by the Heart Failure Association Patient Care committee of the European Society of Cardiology (ESC). It was translated into eight languages, before electronically disseminated by nurse ambassadors, presidents of HF national societies and through social media. A total of 837 nurses involved in the daily care of patients with HF from 15 countries completed the survey. Most nurses, 78% (n = 395) worked within a hospital outpatient setting, and 51% (n = 431) had access to a specialized HF multidisciplinary team. Nurses performed a range of activities including patient education to promote self-care, virtual and in-person symptom monitoring. A third had more than 5-year experience in cardiac care and 22% (n = 182) prescribed HF medications. There was a significant correlation between HF nurses that prescribed HF medications and access to a specialist multidisciplinary team (p = 0.04). A small number of nurses, mainly from Belgium, supported invasive monitoring (n = 68, 8%) with 14% (n = 120) of mostly Danish nurses supporting exercise programmes. The majority of nurses surveyed were committed to further academic professional development, with 41% (n = 343) having completed a HF course.

Conclusion: The role of the HF nurse varies across Europe, however involvement in patient education, symptom monitoring and follow-up remain core to their practice. In specific activities including the prescribing of HF medications and involvement in invasive monitoring, practice has advanced with collaboration in the multidisciplinary team. Consequently, harmonization of education, training and career pathways are required to standardize HF care aligned with expert guidelines across Europe.

Keywords: Disease management; Heart failure; Nurses; Role.

Figure 1

Percentage of heart failure nurse respondents according to country of practice. Percentages expressed as a function of total respondents.

Figure 2

Percentage of heart failure nurses who prescribe guideline‐directed medical therapy according to country of practice. Percentages expressed as a function of total respondents.

Figure 3

Heart failure nurses' access to members of a heart failure multidisciplinary team according to their country of practice. Data were available for 473 respondents This graph shows yes/no responses by country with percentages expressed as a function of the total respondents from each country.

Figure 4

Heart failure nurse involvement in rehabilitation programmes according to country of practice. Percentages are expressed as a function of total respondents.

Figure 5

Heart failure nurse involvement in invasive cardiac monitoring, according to country of practice. Percentages are expressed as a function of total respondents.

Figure 6

Clinical activities carried out by heart failure nurses. Percentages are expressed as a function of total respondents.

Figure 7

Use of patient‐reported outcome measures by heart failure nurses according to country of practice. EQ‐5D: EuroQol 5‐dimensions; KCCQ, Kansas City Cardiomyopathy Questionnaire; SF‐36: 36‐Item Short‐Form Health Survey.