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cost saving for the health service . We want to avoid unnecessary admissions and reduce mortality rates , and we need to build on that together .
Advice for lifestyle change One of the key roles of general practice nurses is to offer education and opportunistic guidance in support of lifestyle change . Many patients I see in hospital with heart failure have multiple comorbidities , such as diabetes or hypertension , and they will have been seen many times for those conditions .
Of course , it is difficult to get people to change their lifestyle ; we need the public to engage in healthy behaviours . Education is needed around things like weight management , alcohol consumption , lipid modification , healthy eating , exercise , stopping smoking , optimising diabetes management and using opportunities such as social referral schemes .
We all need to make every contact count . What is the cause of a patient ’ s leg oedema ? Has a patient who wants advice on losing weight also been tested for diabetes ? Seeing the patient as an individual rather than a set of conditions , as well as making time for holistic review , has never been more important .
Coding If coding isn ’ t right in the general practice records then people with , say , heart failure or AF may not get the follow-up they need . Someone might have been coded with heart failure yet never had an echocardiogram or been seen by a specialist heart failure team , for example . Perhaps they did have an echo in hospital but that information wasn ’ t passed on or recorded in primary care . Getting coding right will provide greater access to resources and follow-up , contributing to better outcomes .
Medication review Medication review performed by the pharmacist or advanced nurse practitioner can be pivotal , of course . Reviewing patients on specific medications – such as sacubitril / valsartan ( Entresto ), which is only used for patients with heart failure with reduced ejection fraction – is an opportunity to ensure they are coded correctly and have appropriate follow-up in place .
GETTY : PATRICK HEAGNEY dispatch to initiate bystander response to someone having a cardiac arrest outside hospital .
What can be done by nurses and other staff in general practice in 2024 ? While I ’ ve not worked as a general practice nurse , I was a chronic conditions nurse for many years in primary care , attached to GP surgeries and seeing patients in their homes . I was then part of an acute response service , and ran a heart failure clinic in a community setting . I now work in an acute setting in Swansea .
Prevention We all need to work together to focus on preventing cardiovascular disease . CVD is largely preventable and there are things that we can do , in primary and secondary care , to reduce the risk . As we know , one of the simplest things – yet the hardest to achieve – is a healthy diet and exercise , and people need support to make lifestyle changes . We need a combination of public health and NHS action on aspects such as smoking and tobacco addiction , obesity and alcohol . Simply eating too much salt results in thousands of heart attacks , strokes and early deaths . Better prevention could result in a huge
Resources
• British Society For Heart Failure . bsh . org . uk
• NHS England . Cardiovascular disease . tinyurl . com / NHSE-CVD
• CVDPREVENT . tinyurl . com / CVD-PREVENT .
• NHS Health Check : Coronary heart disease . tinyurl . com / NHS-Hcheck
• NHS Long Term Plan : Cardiovascular disease . tinyurl . com / LTP-CVD
• NHS Wales . The quality statement for heart conditions . tinyurl . com / Wales-heart
• GRIFT report : Cardiology . tinyurl . com / GRIFT-CVD
• NICE CG181 . Cardiovascular disease : risk assessment and reduction , including lipid modification . nice . org . uk / cg181
• Primary Care Cardiovascular Society . Transform HF Toolkit . pccsuk . org / programme
• NICE NG106 . Chronic heart failure in adults : diagnosis and management . nice . org . uk / ng106
Go online to read the fully referenced article . nursinginpractice . com
Signposting resources and linking with other organisations Lots of educational resources are available for patients with heart failure , and it is important general practice nurses have a full range of information available for patients with chronic diseases . Having that information is really important , as is drawing on the support of other colleagues and having access to social prescribing .
Communication between primary and secondary care We all need to focus on better communication . Was a patient ’ s discharge summary completed when they were discharged from hospital ? If not , that should be looked in to . Without effective two-way communication , we may duplicate or request unnecessary tests , and may lack the full picture of the cause of admission or the care delivered .
Looking ahead The role of nurses in primary care has never been more important . GPNs are in a prime position to make a significant impact on the future health of our society . However , with an ageing population , health inequalities and the problem of undetected heart disease , we need to make every contact count , be proactive and work collaboratively , using all the resources available to us .