7 Nurse-led ambulatory heart failure clinic at queen elizabeth hospital, hong kong SAR

Prior to establishment of the heart failure (HF) nurse clinic at Queen Elizabeth Hospital (QEH), Hong Kong in 2003, high rates of hospital readmission were seen in HF patients. Despite shortage of manpower and resources in the Hong Kong public healthcare sector, the clinic has over the years improved patient outcomes including functional capacity and rates of hospital readmission. Initially, cardiac nurses contributed to promoting patients’ health seeking behaviour through education. By 2012, the clinic provided protocol-guided titration of medications to achieve optimal dosing of medications. The HF clinic nurses would individually titrate and maximise medical therapy according to the pre-set protocol endorsed by cardiologists.1 HF patients were closely followed, particularly for those referred from Outpatient Clinics or recently discharged from hospital requiring medication adjustment and education. On average, HF patients were followed up every 2–4 weeks, and sometimes even weekly for close monitoring. In contrast, follow-up at Outpatient Clinics occurred at 3- to 4 month intervals. Apart from education and medication titration, cardiac nurses of the HF clinic also helped to identify and refer difficult-to-manage patients for advanced treatment such as device therapy. Nurses at the HF clinic have a high degree of autonomy, not only in titrating medication according to protocol but also in customising care plan for patients. The QEH HF nurse clinic has been successful in reducing HF patients’ length of hospital stay and readmission rates (figures 1 and 2), as well as in improving patients’ left ventricular ejection fraction, 6 min walk distance, quality of life, and compliance to diet and medications. Abstract 7 Figure 1 Hospital readmission rates for patients attending the Queen Elizabeth Hospital HF nurse clinic in 2016 and outcome measurement in 2017 Abstract 7 Figure 2 Length of hospital stay (LOS) for patients attending the Queen Elizabeth Hospital HF nurse clinic in 2016 and outcome measurement in 2017 References Hunt SA, Abraham WT, Chin MH, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation 2005;112:e154–235.