Lead Pharmacist, Clinical Cardiology, NHS Greater Glasgow & Clyde
Effective treatment for heart failure needs to extend beyond just the remit of specialists. To see positive outcomes for heart failure patients, we need a more multi-disciplinary approach to care.
Paul Forsyth, Lead Pharmacist for Clinical Cardiology in Primary Care for NHS Greater Glasgow and Clyde, shares his views on why a multidisciplinary approach is essential to effectively treat patients with heart failure.
Q: Why is heart failure such a big concern?
“Heart failure is the most malignant form of heart disease and it affects around 1.5% of the population. It’s not only extremely prevalent, but when you look at how long people with the condition live, then the outcomes are comparable with forms of common cancer. However, the awareness about the severity of heart failure isn’t always there.”
Q: Why is a multi-disciplinary approach needed to treat heart failure?
“While large aspects of care should be managed within the specialist team, heart failure is one of the top ten reasons that people are admitted to hospital, so this is a condition that has implications for many different facets of healthcare. Specialists are there to be the drivers of treatment and care coordination, but without all the generalists backing us up, we are never going to win.”
Q: Who leads care for heart failure patients?
“In the first instance, a patient will be seen by a cardiologist and a heart failure nurse. These are the key roles within the specialist team and are not only vital to planning treatment, but also to exploring the root causes of the condition and whether there are any more complications that need to be taken into consideration. By ensuring any treatment plans are put into place and implemented, the role of the heart failure nurse has been proven to be vital in reducing hospitalisation and improving mortality rates.”
Q: What other specialists are involved?
“We also have dieticians and physiotherapists because we know that giving patients access to information about diet and exercise can help them in the long term. Heart failure and mental health problems often go hand-in-hand as patients struggle through this journey, so a clinical psychologist may be involved too. Pharmacists can be involved in dispensing medicine but may also sit within the specialist team ensuring that medicines are optimised according to individual patient need.”
Q: What role do primary healthcare providers play?
“On a day-to-day basis the GP is the primary caregiver, so it’s vital they know what the treatment plan is and can access the advice of the specialist team. However, there are also other professionals that a patient will see, including pharmacists in the community and general practice nurses. While they may not come up with the next steps of a treatment plan, these professionals are critical because they see the patients regularly and can pick up on any significant changes in their health.”
Q: How can patients help themselves?
“There is lots of self-management a patient can learn to take on to help themselves – and not just with regard to their diet and exercise. For example, one of the main symptoms of heart failure is oedema, where a patient retains extra fluid. We can educate patients that if they start to see their weight going up over a few days then they should get in touch with their specialist team.”
Q: What can be done to encourage a team approach?
“At a UK level, there is a willingness to have a multi-disciplinary approach to treat not only heart failure, but other conditions. Everybody understands that with multi-morbidity and an ageing population, it’s important to have good knowledge of what every discipline brings to the table, so we can pick up the phone and talk to each other.
“In Scotland, we now have shared IT platforms for clinicians from different sectors to access. GPs need to be updated as they are the person that patients go to first, but we also need to make sure that things like blood test results, discharge letters and the anticipatory care plans are on a shared platform where all key stakeholders can access them.”