Clinic keeping hearts beating

HEART failure is one of the top conditions generating the most visits to emergency departments, including at Ballarat Health Services.

BHS cardiac nurse practitioner Linda Macaulay said it’s a “huge burden” in more ways than one.

“Apart from the burden of illness and a lack of quality of life for people, heart failure is also a huge burden on our health system,” she said.

Aiming to reduce heart failure patients’ hospital readmission rate, with evidence-based, personalised care, and targeted treatment, BHS has its own heart failure clinic.

“The hospital readmission rate is really large, and not just for readmitting with heart failure, but with a wide variety of comorbidities which upset the heart, like diabetes, cognitive impairment or a respiratory disease,” Ms Macaulay said.

“Our clinic runs to deliver consistent care for every patient every time, because our patients that we see are our friends, family members, relatives, work, and school mates.

“We’re looking after people in our community, so we want to give them the best possible care so they can live their best lives, rather than be burdened with comorbidities, and dying early.”

Ms Macaulay said people with heart failure are referred straight to the clinic, however her team also works to identify patients who have presented to the hospital with other concerns, but likely have heart failure too.

“We’re working hard with pharmacists and physicians, and have some IT tools to help identify them, so every heart failure patient every time is identified.

“They get a specific evidence-based bundle of care, like targeted education to help them understand their condition, understand their medications, and signs that they’re getting sick,” she said.

After heart failure patients leave the hospital, the clinic has a role in supporting them in the long term.

Nurses call regularly, clients get a medical review within seven days of discharge, they can call a help line for timely advice, access health independence programs, or cardiac rehabilitation, and in-home care from the BHS @ Home program.

“People in the Grampians region don’t have good access to GPs, so how they are discharged home, and what their follow-up is, really matters,” Ms Macaulay said.

The role of Adam Livori, a cardiology pharmacist, is to ensure these people have evidence-based medications, which “save lives, reduce death and disability,” and if they need help, they can call him.

“We know when patients have a proper pharmacological review with a pharmacist, they’re far more likely to consistently take their medications because they really understand what they do,” Ms Macaulay said.

“Continuity of care between practitioners is key in Ballarat. Linking up community programs, we can reduce the gaps in care.”

Barry Nixon has been a cardiac patient since February 2006 and said navigating heart failure for the first time can be very “confusing.”

“The heart failure clinic, and other patients via peer support, really help new patients and empower them through discussion,” he said.

“It’s great to share the journey with others. You gain a lot of confidence, and your fear lessens.

“It’s also the first time there’s been a dedicated clinic helpline. New patients have a lot of questions and fears, and that number is a valuable and helpful resource.”

Mr Livori said the internal partnerships between BHS’ cardiology department, heart failure service, and pharmacy are “innovative.”

“You don’t see this kind of collaboration in a big metro health service. Ballarat is a real contender,” he said.

The BHS heart failure clinic is part of a broader Heart Failure Collaborative with 19 other health services across Victoria aimed at improving patient safety.

“The powerful thing about all of this is that everyone’s aware of each other’s successes, and learning from them,” Mr Livori said.