1. Heart Failure Programs Europe and Belgium Sandra Martin Clinical Nurse Specialist UZ Leuven, Belgium

2. ESC guidelines  “an organized system of specialist heart failure care should be established to improve the outcome of patients with heart failure (class 1A)”  “depending on the local health care systems, it seems important to determine which health care provider is the most appropriate to participate in various components”  “nurses and other health care providers can play an important role in these innovative forms of care” Swedberg K et al., Eur Heart J. 2005; 26: 1115 – 40.

3. HF in Europe  20 years ago Sweden established the first type of HF programs in Europe  Stimulate the development of HF programs in Europe  What is the current situation in Europe?  Study: 2003 - 2005 To identify the number and content of HF programs in Europe To identify the number and content of HF programs in Europe Jaarsma T et al., Eur J Cardiovasc Nurs. 2006 Sep;5(3):197-205.

4. HF in Europe  Research questions: 1. Which European countries have established HF management programs and in what proportion relative to the number of hospitals? 1. Which European countries have established HF management programs and in what proportion relative to the number of hospitals? 2. What are the characteristics of the HF management programs (e.g. referral system, personnel, setting, and funding)? 2. What are the characteristics of the HF management programs (e.g. referral system, personnel, setting, and funding)? 3. What is the specific content of these HF management programs? 3. What is the specific content of these HF management programs? Jaarsma T et al., Eur J Cardiovasc Nurs. 2006 Sep;5(3):197-205.

5. HF in Europe BELGIUM < 30 % HF PROGRAMS ??????

6. HF in Belgium  A total of 139 hospitals were invited to fill in the questionnaire (email – regular mail) Cardiologist specialized in HF Cardiologist specialized in HF Head of cardiology Head of cardiology Head of internal medicine Head of internal medicine Heart failure nurses Heart failure nurses University Hospitals University Hospitals Regional Hospitals with extended cardiology facilities Regional Hospitals with extended cardiology facilities Regional Hospitals Regional Hospitals

7. HF in Belgium  A total of 35 (25.2%) responded to the questionnaire  Of which 18 (12.9%) had a HF management program (  Of which 18 (12.9%) had a HF management program (Non-responding hospitals were categorized as no HF program)  5 plan to start a HF program A program delivering coordinated and comprehensive treatment and care specifically targeted at HF patients, such as a HF outpatient clinic, a HF home program or a HF multidisciplinary team.

8. Setting  In-hospital and outpatient clinic: 13  Outpatient clinic: 4  Combined hospital and home-based: 1

9. Follow up  Follow up after hospitalization and/or HF control: Cardiologist: 6 Cardiologist: 6 HF nurse: 0 HF nurse: 0 Cardiologist and HF nurse: 12 Cardiologist and HF nurse: 12  Palliative care: 5  Home visit: 2

10. Referrals  Hospitalization unit: 11  Cardiologist: 16  Internist/geriatrician: 2  Primary care physician: 13  Home care: 2  Patients themselves: 3

11. Content HF program Patient education 18 Patient initiated telephone consultation 15 Medical changes (protocol) by nurse 5 Physical examination by nurse 15 Education of other health care providers 7 Coordination of care 11 Nurse-initiated telephone follow up 11 Psychosocial interventions 13 Exercise training 14 Behavioral interventions 15

12. Patient education  Verbal and written information: 18  Group information: 6  Computer based education: 3  Educational video: 0  Family education: 14

13. Nurse education/training  Nurse assistant (A2) : 3  Bachelor (A1) degree: 16  Masters degree: 3  In-service training: 13  HF courses: 12  Extensive cardiac care experience: 12

14. Funding  Hospital: 14  Department of Cardiology: 12  Home care: 0  National health care system: 3  Pharmaceutical companies: 0

15. Multidisciplinary team  Regular meetings: 9  Cardiologist: 18  Nurse: 16  General practitioner: 12  Social worker: 12  Psychologist: 13  Physiotherapist: 11  Dietician: 12  Primary care nurse: 4

16. Evaluation of care/research  Clinical trials: 12  Quality of life: 5  Readmission rate: 5  Survival: 5  Patient satisfaction: 4  Tele-monitoring: 3

17. Discussion  Low response rate Reminder Reminder Fill in now at the symposium! Fill in now at the symposium!  Large gap between the evidence and the application of HF programs (health care system)  No systematical evaluation of the service (outcomes)

18. Discussion  Need for academic nurse education/ core curriculum/ certification  Findings similar to Europe study: Less home care service Less home care service Greater multidisciplinary involvement Greater multidisciplinary involvement

19. Conclusion  Despite the evidence of specialized care for HF patients  Only 18 HF clinics exists in Belgium In and out of hospital care In and out of hospital care Multidisciplinary team: cardiologist/nurse Multidisciplinary team: cardiologist/nurse  Need for more involvement of the primary care physician/nurse  HEALTH CARE SYSTEM CHANGE to increase the number of HF clinics

20. Thank you for participating in this survey