Beyond NYHA class. an advanced nurse practitioner led multidomain assessment of older adults with heart failure
T Mannion, E Higgisson, V MaherAbstract
Background
Heart failure (HF) is increasingly recognised as a multisystem condition in which sarcopenia, frailty and malnutrition contribute significantly to symptom burden, reduced functional capacity and adverse outcomes. Traditional HF assessments often focus on cardiac parameters, with limited evaluation of functional and nutritional domains. We implemented and evaluated an Advanced Nurse Practitioner (ANP)-led HF first review service incorporating structured multidomain assessment to identify vulnerability and guide personalised management
Methods
Over a 3-month pilot period, all patients over the age of 65 attending an ANP-led first review HF clinic underwent comprehensive multidomain assessment including sarcopenia screening (SARCF Questionnaire), frailty assessment (Clinical Frailty Score), New York Heart Association (NYHA) functional class, and malnutrition screening (Mini Nutritional Assessment Short Form). Assessments were embedded into routine clinical review and used to inform individualised care plans, including optimisation of HF therapy, referral to dietetics, physiotherapy and community supports. Data were collected as part of a service evaluation.
Results
80 patients (54 male, 26 female) aged ≥65 years (mean age 78 years) underwent multidomain assessment by HF ANP. A high prevalence of non-cardiac vulnerability was observed mong older patients with HF including a high degree of sarcopenia (45%, n=35), frailty (51.2%, n=41), and nutritional risk (52.5%, n=42). Although SARC-F and CFS scores increased and MNA-SF scores declined with advancing NYHA class, sarcopenia, frailty, and nutritional risk were evident across the full spectrum of NYHA classification (Table 1). Prompt identification of these factors facilitated early targeted multidisciplinary referrals: 56% of patients (n=45) to dedicated exercise programmes/physiotherapy, 49% (n=39) to dietetic services, and 54% (n=43) to community education and lifestyle support via the Irish Heart Foundation Heart Connect service. Additional referrals included community palliative care services (5%, n=4), age-related community services (22.5%, n=18), and multidisciplinary team discussion (25%, n=20).
Conclusion
An ANP-led first review heart failure service incorporating multidomain assessment is feasible. It improves detection of sarcopenia, frailty, and malnutrition and facilitates early appropriate multidisciplinary team involvement. Integrating functional and nutritional assessment alongside NYHA classification may enhance patient care and support personalised, person-centred management. This model underscores the expanding role of advanced nursing practice in heart failure management, enabling delivery of personalised, person-centred care through a multidimensional approach.For image description, please refer to the figure legend and surrounding text.