1. West Essex Frailty Pathway: Heart Failure
Once therapy optimised consider ongoing review by primary care OR by community matron if ongoing poor symptom control
Confirmed case of heart failure due to LV systolic dysfunction (LVSD) (Ejection Fraction <50%)
Optimise medication with angiotensin therapy and beta blocker if tolerated – consider input by heart failure nurse for monitoring and titration of medication
If acute onset increase in symptoms – assess severity (use (NEWS) Early Warning System to guide) – consider increase in diuretics for mild fluid overload and arrange ongoing review
EWS ≥ 5
Evidence of severe exacerbation? Tachycardia hypotension, drowsiness, hypoxia, severe tachypnoea at rest
EWS 1-4
Evidence of mild to moderate exacerbation?
Admit to acute hospital
(if this is not an expected terminal event in a patient on an end of life care pathway)
Contact heart failure nurse for advice or urgent assessment if patient has social factors/care needs that could complicate management at home. Heart failure nurse can arrange same day face to face assessment or suggest/arrange urgent assessment via SPA at RAC or in community bed.
SPA contact Monday to Friday 8am – 5pm for arranging admission
Community Specialist Heart Failure Nurses can:
Assess and titrate cardiac meds for patients with confirmed LV systolic dysfunction. Once medication optimised will discharge back to community matrons and/or primary care for ongoing review
Reassess if exacerbation of heart failure is evident
Telehealth for appropriate patients
Signpost to primary care and end of life teams if evidence of severe end stage disease is present and end of life can plan may be required
Advice and guidance
Single Point of Access (SPA) 08:00-21:00, Seven days a week
Telephone: Fax: