Specialist Heart Failure Services
What do we do?
The specialist heart failure team are involved with the care of patients with heart failure in both the hospital and community settings, from the time of diagnosis of this condition.
We assess and monitor each individual to ensure appropriate medications and treatments are started. We also aim to ensure that these are given at the correct doses to optimally manage this condition. As well as medication optimisation, consideration will also be given to the need for more complex interventions such as specialised procedures or devices.
We also aim to improve the individual’s knowledge and ability to self monitor and manage their condition. We do this in a supportive environment providing information and advice about their condition and treatments.
We work collaboratively with other agencies and specialists to provide high quality individualised care for all our patients and their families. This includes all our colleagues in the cardiothoracic centre, as well as the cardiac rehabilitation team, pharmacists, GPs, community matrons and psychological services.
A further aspect of the team role is to liaise with other health care professionals. We do this by advising and educating them regarding the management of heart failure.
We undertake regular audits to ensure the care we provide is of the highest standard. We are also involved with research into treatments aimed at improving heart failure and its management.
What happens during an appointment with a member of the team?
At your appointment with the heart failure team you may see a doctor, nurse or a pharmacist. Your appointment will be tailored to suit your needs.
You may see us when you are initially diagnosed with this condition or as part of your ongoing care. A number of assessments may be undertaken at these visits. This includes asking you about your symptoms and how these are affecting you.
We will also check your blood pressure and your pulse on every visit and we may examine your chest and check for signs of fluid on your legs. On some occasions other tests including blood tests or additional scans of the heart may be requested.
The aim of these assessments is to ensure that the treatments and medications are tailored to your needs. Many heart failure medications are started at smaller doses and then gradually increased. It is not unusual to have your medications increased or changed several times.
We may also refer you to other health care professionals both in the hospital and community if we think they can help in your care and treatment.
An important aspect of our role is to provide information, support and advice to our patients and their families. This includes information about their condition and how to manage it. We know from research and experience that this can help patients and their families recognise signs and symptoms that may indicate that their condition is deteriorating.
This helps people feel more comfortable and confident about managing their condition and this can help to reduce the chance of being admitted to hospital with heart failure symptoms.
What is heart failure?
Heart failure occurs when the heart becomes less efficient at pumping the bloods around the body. The term heart failure can sound quite frightening when heard for the first time. Heart failure does not mean the heart is failing and going to stop, but rather that it is failing to work as well as it used to do. Heart failure can affect people in many ways and symptoms vary from person to person.
Common symptoms include shortness of breath, a reduction in the level of activity and swelling of the ankles, lower legs or abdomen. Some patients also feel very tired or fatigued. The swelling of the ankles, lower legs and abdomen is caused by an accumulation of fluid in the body.
For most people heart failure is a long term condition. This means that it will require long term management, even if the person with heart failure feels well.
Sometimes heart failure symptoms can occur acutely, this is when the symptoms deteriorate quite suddenly. This may be when it is first diagnosed or due to other factors such as a change in the condition, a change in medications or other health problems influencing how well the heart can function.
There are many different reasons why heart failure occurs. The most common causes include heart attacks and high blood pressure. Other causes may include diseases of the heart muscle (cardiomyopathy), heart valve problems, viral infections, high alcohol intake, recreational drug use, lung disease and abnormal heart rhythms. Sometimes it is not always possible to determine the cause.
The treatment for heart failure aims to improve your symptoms, to keep you as well as possible, and to prevent your condition from getting worse. Heart failure and its symptoms are managed using a combination of medicines.
Sometimes there are other treatments that may help with your condition, these include pacemakers, specialist pacemakers and devices such as cardiac synchronisation therapy (CRT) and internal cardioverter defibrillator (ICDs).
What advice and information is given to people with heart failure?
The heart failure team will provide information and advice to the patient to meet their specific individual needs. However for many patients with heart failure some general areas of advice and information are very similar.
- What heart failure is and the common symptoms.
- Possible causes of heart failure.
- Treatment options for heart failure.
- The benefits of smoking cessation.
- Ensuring alcohol limits are kept within recommended limitations. That is 14 units per week for men and women. Some people may be told to avoid alcohol completely.
- Avoiding a high salt diet. We do not recommend the use of salt substitute products.
- Keeping active within realistic limits. We can refer you to our heart failure cardiac rehabilitation programme to help with this.
- Taking medications as prescribed and recommended. We can help you with strategies to ensure you are less likely to miss or forge doses.
- Keeping up to date with vaccinations for influenza and pneumonia.
- Checking for signs of having additional fluid in the body, for many people this may involve weighing themselves everyday.
- Some patients with heart failure may be advised not to drink large volumes of fluid.
The team is made up of a variety of health care professionals from different disciplines. We work across the hospital and community setting in the Middlesbrough, East Cleveland, North Yorkshire and Richmond and Hambleton areas.
The members of the team all have a specialist interest in caring for patients with heart failure. The team consists of:
- Five consultant cardiologists
- Two local GPs
- Five specialist nurses
- A cardiac pharmacist
We work closely with several other health care professionals and teams. These include the other consultant cardiologists, pharmacists, the cardiac rehabilitation department, ward staff, GPs and clinic staff.
All members of the team are experienced practitioners at caring for patients with heart failure. They have all completed, or are working towards additional specialist qualifications relating to the role.
Heart failure specialist nursing team contact numbers and helplines are:
- The James Cook University Hospital – 01642 835865
- Friarage Hospital – 01609 764698
Although a heart failure nurse is usually in the hospital at The James Cook University Hospital Monday to Friday from 8am to 5pm, we are often not in the office, therefore if a name and telephone number is left on the answering machine we can return the call as soon as we have opportunity.
This telephone number can be used for gaining information and advice regarding heart failure. This should not be used for medical emergencies. For medical emergencies ring 999. For advice about other (non heart failure) medical matters and conditions that are not emergencies the GP surgery should be contacted.
Community diagnostic clinics.
These are predominately undertaken by GPs with a specialist interest. The aim of the clinics is to provide a service to allow for a timely diagnosis of heart failure. Referral to these clinics is made by the patients GP.
The consultant clinics are held at The James Cook University Hospital and Friarage Hospital. You may be seen by the consultant or a member of their team who will then liaise with the consultant.
Heart failure specialist nurse clinics
The heart failure specialist nurse will review patients that have been referred to them by a consultant cardiologist or GP with specialist interest. These appointments are usually 30 minutes long.
Often the focus of these appointments is to ensure the patient understands their condition and the medications are correct. Sometimes you may be seen by a pharmacist to help with this process. A number of clinics are held by the heart failure specialist nurses.
These are held at:
- The James Cook University Hospital
- Friarage Hospital, Northallerton
- One Life Centre, Linthorpe Road, Middlesbrough
- Redcar Primary Care Hospital
- Low Grange, Eston
- The Friary, Richmond, North Yorkshire
- Leyburn Medical Practice, North Yorkshire
- British Heart Foundation
- Heart failure information from NHS Choices
- Pumping Marvellous
- Atrial Fibrillation Association