Collaborating to take an active role to improve heart failure: Heart Foundation and NPS MedicineWise

Picture of a loveheart (red border, white inside) including small icons of people, pills, containers, clocks, brains, microscopes with an eye inside the lens, all located within the heart. Text says: Heart Failure. An active role for GPs and patients. Logos of Heart Foundation and NPS Medicine Wise

Brooke Atkins & Amanda Buttery, National Heart Foundation of Australia

PHAA’s Note: This article does not constitute medical advice. If you have heart failure, please see your doctor before starting exercise or physical activity.

Heart failure is a serious condition where the heart does not pump blood to the rest of the body as well as it should. Heart failure affects 480,000 Australians and is associated with high rates of hospital admissions and death.

For people diagnosed with heart failure, the prognosis is worse than some common cancers. The chance of being alive five years after being diagnosed with breast cancer is 78% compared to 50% for women with heart failure.

Better survival after heart attacks and ageing populations are driving the globally rising prevalence of heart failure. By 2030, it is estimated that as many as 750,000 Australians will be affected by heart failure.

Early diagnosis and effective management improves survival, decreases hospitalisation, and improves quality of life for people living with heart failure.

We have collaborated with NPS MedicineWise to develop a national program: Heart Failure: taking an active role. The program aims to support health professionals in primary care, and their patients and carers, in the diagnosis and management of heart failure.

A multidisciplinary expert working group was convened to develop the program with input from cardiologists, nurses, general practitioners, pharmacists, public health practitioners, other health professionals and people living with heart failure. The program’s activities are informed by application of the Theoretical Domains Framework, behaviour change strategies, and audience user-testing and consumer engagement.

Our key messages are simple and consistent with the Australian clinical guidelines for heart failure. Messages are targeted to both health professionals in primary care and people living with heart failure to address known practice gaps and barriers to self-management.

To keep people with heart failure out of hospital and living better, longer lives, the program focuses on:

  • Early diagnosis and classification of heart failure to guide management
  • Initiation and medicines management
  • Early and ongoing patient education and self-management.

Key features of the program include free educational visits to general practices, by NPS MedicineWise educational visitors, provided both digitally and in-person. Visits are taking place between March 2021 and February 2022. As of September 2021, just over 4,000 visits have been completed, and around a third of these have been delivered in regional or remote Australia, either virtually or in-person.

The program also provides a suite of online material including clinical resources and tools for health professionals and patients.

Evidence shows that a person-centred multidisciplinary team approach is central to improving the lives of those with heart failure. As part of the program, a webinar featuring a general practitioner, nurse, pharmacist and person living with heart failure explored the role of different health professionals in the multidisciplinary team. It’s available freely online.

The program offers free resources for people living with heart failure, including action plans, factsheets and booklets for patients and their carers to support self-management.

Effective patient education contributes to better self-management for people living with heart failure. It is vital that information is provided in an accessible way. This includes translated resources to overcome language barriers. Simplified resources for people with low health literacy and language skills are crucial to ensure people understand their condition and have the knowledge to take an active role in their health and care.

The Heart Foundation has launched a series of videos available in Arabic, English, Greek, Italian, Vietnamese, and Mandarin for people living with heart failure. These videos aim to help people understand heart failure and develop self-management strategies.

Exercise and physical activity are strongly recommended for people with heart failure in clinical guidelines. For people living with heart failure, attending a cardiac rehabilitation program reduces hospitalisations, supports long-term lifestyle changes, and improves peoples’ quality of life. The Heart Foundation has recently updated its cardiac services directory to help people and health professionals find their local services.

For some people, a common barrier to attending a cardiac rehabilitation service is proximity, with long distances to travel preventing participation. Digital health has increased the range of ways cardiac rehabilitation programs are being delivered, including more options via telehealth and home-based services.

The Australian Cardiovascular Health and Rehabilitation Association and the Heart Foundation published a position statement in 2020 highlighting how telehealth can complement face-to-face care, giving more people the opportunity to benefit from cardiac rehabilitation. This is an underutilised treatment that can greatly influence lifestyle changes like smoking cessation, physical activity levels and heart-healthy eating. Additionally, to improve the quality of care in cardiac rehabilitation services, both organisations worked together to develop 10 quality indicators to inform best practice service delivery models. Indicators include time to enrolment, a comprehensive assessment of cardiovascular risk factors, depression screening and assessment of smoking.

The advantages of this partnership have included reducing duplication of work by leveraging existing assets and ensuring consistent messaging for health professionals and consumers. This is aligned with national guideline recommendations to achieve greater collective influence.

Program evaluation will include measurement of changes to general practitioners’ knowledge, confidence, and prescribing behaviour.

We will be evaluating changes in patients’ and carers’ understanding of heart failure and adherence to heart failure medicines in the context of their health literacy.

Through collaborating to develop this program for health professionals in primary care and the people, and carers, that are living with heart failure, we aim to keep people out of hospital, and help them live better, longer lives.

The NPS Medicine Wise heart failure program is funded by the Australian Government Department of Health.

Disclaimer: Do not use any information in this piece to treat or prevent any condition. This information is not a substitute for the advice of a healthcare professional. Consult your general practitioner before starting any new therapeutic or exercise program. We accept no liability for damage, injury or loss due to information provided.

Image: Heart Foundation/NPS Medicine Wise

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