Today I had the opportunity to sit in on a clinic with the heart failure nurse. We saw 4 patients that had heart failure aswell as other long term conditions.

I found the experience insightful and enjoyable. On this occasion the patients were follow up patients. The nurse conducted thorough reviews, which included assessing current medications, discussing how the patients were feeling holistically, reviewing recent blood results, and considering any necessary interventions. She also performed physical assessments, such as auscultating the lungs for any abnormal sounds.

I also was introduced to the heart failure in traffic light patient self-monitoring and management leaflet. The leaflet included information on establishing a daily routine, an explanation of what heart failure is, common symptoms, possible causes, contact details for the heart failure team, and an overview of the four pillars of medication used to manage the condition.

The heart failure nurse also expressed to me the importance of asking the patients how many pillows they sleep with at night. This is important because it can indicate how breathless the patient is. For example, if the patient sleeps with 1-2 pillows and this is their normal before they were diagnosed, then this is ok. However, if they have to sleep with more then 2 or in some cases have to sleep completely sitting up right or in a chair this shows that the patient is extremely breathless.

I learnt that the four pillar medication to treat heart failure is are ACEiS: Ramipril, Lisonopril, Enalapril/ARBs: Candesartan, Losartan, Valsartan/ ARNI: Sucubitril Valsartan (Entresro). Beta Blockers such as Bisoprolol, Nebivolol, Carvedilol. MRSAs: Eplerenone/ Spirononlactone. SGLT2s: Empagliflozin/ Dapagliflozin.

Diuretics such as Furosemide and Bumetanide may also be used for fluid offloading and symptom control if you have fluid retention.