Toward a multidisciplinary approach: The increasing involvement of nurses in heart failure management

Abstract

Introduction

The increasing prevalence of heart failure (HF), alongside the scarcity of medical time, necessitates the development of new practices and the promotion of task-sharing and skill-sharing. Over the past few years, new professions have emerged to facilitate the care of patients with HF: specialized nurses in heart failure management (ISPIC), advanced practice nurses (IPA), and telemonitoring nurses (ITS).

Objective

In spring 2023, the GICC (Groupe Insuffisance Cardiaque et Cardiomyopathies) distributed a questionnaire via email and social networks to better understand these new professions.

Method

196 usable questionnaires were collected, of which 106 (54%) had exhaustive responses. The majority of respondents were IPAs (59 (47%)), 45 (36%) were ISPICs, and 21 (17%) were ITSs. The average age was 44 years, similar across the three groups. Respondents had a median of 11 years of experience with CV pathologies, but IPAs had significantly less time working with cardiac patients than the other two groups.

Results

57% of IPAs, 81% of ISPICs, and 80% of ITSs have exclusive activity in cardiology (P = 0.021). Outside of cardiology, the most frequently invested specialties are diabetology, geriatrics, and vascular medicine. 48% of the nurses exclusively work with HF patients.

Professional practice is mainly in public hospital structures (66%), with non-university hospital centers leading. Private practice is more common among IPAs than other professions (29% of IPAs vs. 5% for ISPICs and 0% for ITSs; P < 0.005).

Consultations for uptitration of medical therapy are conducted by 72% of IPAs and 55% of ISPICs. 94% of IPAs and 48% of ISPICs conduct clinical and biological follow-up consultations. A majority of nurses already perform or are in the process of implementing tools to coordinate patient care pathways. 70% of ISPICs participate in therapeutic patient education workshops, compared to only 37% of IPAs and 44% of ITSs (P = 0.049). 100% of ITSs conduct telemonitoring, compared to only 46% of IPAs and 80% of ISPICs (P < 0.001).

Conclusion

This initial study highlights the already effective involvement of specialized nurses in the care of HF patients, despite disparities in training and practice mode. It also highlights differences in roles with patients for each of these professions. Studies with larger populations will further refine this preliminary work.