Nurse-led clinic for heart failure with preserved ejection fraction

Background/Introduction

Following updated heart failure guidelines from ESC in 2023, SGLT2i became a class 1 recommendation for patients with HFpEF. This in turn created a need for this group of patients to be reviewed in secondary care so that SGLTi could be initiated under specialist guidance where appropriate.

Purpose

To address this increased demand, a Nurse-led HFpEF clinic was established to review patients referred who likely met the criteria for a HFpEF diagnosis. This clinic was Consultant supported and delivered by the HFSN.

A key aim was to reduce waiting times to be reviewed. The provision of HF education is an important part of the management of such patients and given this is often delivered by the HFSN, this nurse-led HFpEF clinic was the most appropriate place for these patients to be seen.

Methods

A prospective registry of the HFpEF clinic was made. Referrals were required to meet the eligibility criteria for suspected HFpEF and diagnosis and management was based on ESC guidance. There was emphasis on the management of risk factors such as diabetes, hypertension, obesity and rhythm/rate control of atrial fibrillation.

Six patients were scheduled per clinic, with 30-minute appointments. Referrals were vetted by Heart Failure Consultants before being allocated to clinic. The clinic was set up for single appointments and no follow ups were scheduled. Should patients need ongoing review then they were referred to relevant cardiology clinics but otherwise a comprehensive management plan was provided for their GP. For patients who presented with significant decompensation, they were referred to the community Rapid Response team for ongoing review to avoid hospitalisation.

The protocol emphasised the importance of patient education regarding fluid overload and traffic lights system as well as sick day rules around SGLT2i.

Results

The clinic was established in February 2025 and overall, 134 patients were given appointments. A diagnosis of HFpEF was made in 72% of patients and in the remaining patients they were not felt to be suffering from heart failure but their symptoms were related to other conditions such as renal failure. The commonest causes of HFpEF included arrhythmia, obesity-metabolic syndrome and cardiac amyloidosis. In total, 55% of patients were prescribed SGLT2i and 51% of patients were offered diuretics. Following clinic, 91% of patients were discharged back to primary care, 6% had ongoing follow-up with the heart failure clinic, 2% were referred to the arrhythmia clinic and 2% were referred to the valve clinic.

Conclusions

A streamlined nurse-led HFpEF clinic is an efficient way to review patients with suspected HFpEF. Patients are seen quicker than if they had been reviewed in consultant clinics and are provided with in-depth education. Having a designated HFpEF clinic allowed them to be reviewed by a clinic specialist to provide appropriate diagnosis, education and initiate SGLT2i to reduce morbidity.