Nurse Practitioners (NPs) lead the Heart Failure Resource Center (HFRC) Program, including the clinic and the ongoing patient care plans. Physicians assist in the development of patient care protocols that direct the care delivered in the clinic setting. Physicians are not present in the clinic but are readily available for consult by the NPs if needed.

NPs in the HFRC assess and evaluate the heart failure patient's needs and response to care. In the clinic, the NPs adjust and optimize medications as necessary to improve patients’ heart failure status and relieve any heart failure symptoms. If patients are mild to moderately decompensated at time of an HFRC visit, NPs are able to intervene with IV diuretic therapy in order to avoid emergency room visits or hospitalizations. Electrolyte and BNP testing is available in the clinic for evaluation at the time of patient visit.

The team provides ongoing education for the patient, family, and significant others, as well as early intervention and management of the patient's health status. In addition, nurses collaborate with physician and healthcare professionals to provide coordinated care to the patient and family. They also connect patients with available community resources, maximizing the self-care capabilities of patients and families receiving care.

The majority of HFRC patients are referred by their physician as part of their discharge plan from the hospital. Basic heart failure education and self care information is delivered before hospital discharge, and patients are sent home from the hospital with comprehensive assessment tools to complete and bring to their initial HFRC visit, which is scheduled for 10 to 14 days after discharge. These tools assess the patient’s knowledge of heart failure, functional ability, self care ability, and quality of life.

The patient’s first visit to the clinic is comprehensive and takes up to two hours. The NP conducts a complete physical exam and history, including having the patient complete a six-minute walk and a baseline hemodynamic profile. The patient brings the completed screening tools and all current medication bottles to the clinic visit. The staff performs a comprehensive review of the patient’s medications and educates the patient about medication management. During this visit, a nurse and the patient complete screening tools for depression and sleep apnea. A significant portion of the first visit is reserved for education for the patient and her/his caregiver(s) about managing heart failure.

At weekly “Grand Rounds,” a dedicated heart failure multidisciplinary team of NPs, a Clinical Nurse Specialist, staff RN’s, a clinical pharmacist, a cardiac rehab specialist, a clinical case manager, the program manager, and medical directors discuss each new patient’s case and sign-off on the care plan proposed by the NP.

Patient progress towards being optimized on their medications and clinical protocols, discussed below, determine how often patients come to the clinic for lab tests and appointments.

The care provided by the HFRC staff is based on evidence-based protocols developed by the multidisciplinary team and approved by the medical directors. Each protocol guides the NP in optimizing a patient’s heart failure management and/or medications. The protocols help determine how often a patient comes to the clinic for an NP visit and to have laboratory work done.

The Fuqua Heart Failure Resource Center updates all protocols annually. In addition, the Fuqua Heart Center includes a large research division, which provides the Heart Failure Resource Center’s physicians and clinical staff access to the latest research findings. Protocols can be updated between review cycles if needed.

For the most difficult cases, the HFRC has the ability to manage patients using telemonitoring provided by WebVMC’s RemoteNurse telehealth system. Patients are provided with a touch-screen computer, scale and blood-pressure cuff that plug into their home phone line. They use the system daily to monitor heart failure symptoms, weights, blood pressure and heart rate. These readings are transmitted to the HFRC staff on a daily basis.

The program is user-friendly, accessible via the Internet, and cost effective. The information is available anytime from a PC, laptop or smart phone, and the program immediately notifies nurses about any readings that are potentially problematic. Approximately, 70 of the 300 patients participate in the web-based telemanagement program.

In addition, the clinic gives a scale to any patient who does not have a clinic-approved model at home.