with a HF related admission in the last 6 months Consider adding those not on maximum tolerated therapy with another LTC or disengaged If patients are not covered by these groups still consider a review ID: 933965
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HF Cohort:
Those on who have NYHA III+ who have not had a review in the last 6 months or
with a HF related admission in the last 6 months
Consider adding those not on maximum tolerated therapy,, with another LTC or disengaged. If patients are not covered by these groups, still consider a review.
ReviewReview in conjunction with other conditions, e.g. that register them on other cohorts/listsIf no BP in last 6m, contact to arrange loan of BP machine via text If no Bloods in last 6m (or more recent in CKD), arrange phlebotomyReview if has completed cardiac rehabCheck if on maximum tolerated therapy
Remote ConsultationBy GP/Nurse/PharmacistConsider who has relationship with the patient already, who has the relevant expertise, workforce capacity and whether the patient needs a consult for other reasons e.g. another LTC, MH, social supportConsider review as a householdVideo Consultation preferred but phone call otherwiseDiscussBlood pressure and heart rateBlood resultsBreathing (consider HF or other causes), exercise tolerance, orthopnoea/PND. Remote Consultation guidance Fluid overload incl weight if they have scales. Use video consult to review oedema in legs. Consider diuretics if overloaded and follow up with blood test for electrolytes and BP check.LifestyleDietFluids/salt restrictionsExerciseSmokingImmunisation – Flu and PneumococcalMedicationAdherenceSide effectsSupply of medicationAwareness of symptoms of Heart failure and exacerbationsChest pain/palpitationsDiscuss EoL plans and update CMCCovid-19 advice e.g. on Isolation/Shielding, and how to seek help Social Support : https://community.hackney.gov.uk/Family issuesPractical support/ other issuesLink to IAPT for LTC:https://talkchangesforhealth.org.uk
When to refer to ACERS HFweight gain >2kgpitting oedema above mid shinany new oedemanew orthopnoea or PND Clinical concern e.g. whether HF cause of SOBAdvice and guidance available from ACERS - Link to GP Website: https://gps.cityandhackneyccg.nhs.uk/coronavirus-covid-19/cardiology-1
Follow upAdd review time/date and code for follow up Consider scheduling an AccuRx Pathways text message
Medium Term Proposal for Management of Heart Failure
Generate list of patients using searches
For GP/Nurse/Pharmacist to review who to contact.