254 Improving care for congestive heart failure by transfering competency to specialised nurses

Background Chronic Heart failure management is based on ESC recommendations. In most countries, medical therapy is based on a medical examination and despite the improvement of medical therapies; most of CHF patients are not optimally managed. Nurses are more and more implicated in CHF management. Methods We have compared double blind medical prescription of a Heart failure trained Nurse (specific training on CHF, ESC recommendations, BNP use and pathophysiology, patient education) and a heart failure specialised cardiologist in 120 consecutive patients. We focusing on clinical examination, BNP interpretation, treatment evaluation and therapeutic modifications proposed. Results We have included 120 consecutive patients. Mean age was 70.2±5. Mean LVEF was 32±5%. Mean BNP was 230±120 pg/ml NYHA classification was similar in 85% of cases. Treatment evaluation was similar in 89% of the patients and 96% of patients considered as under optimal therapy by the heart failure specialist were identified by the HF nurse. Therapeutic modifications proposed by HF nurse were confirmed by the HF specialist in 85% of the patients. ESC recommendations were followed in 100% of the cases. Differences in prescription between HF nurse and HF specialist are mainly related to spironolactone/Angiotensin II receptor antagonist introduction in addition to ACEI therapy. Conclusion A trained HF nurse could act as first line prescriber in CHF with a low risk profile. Donnees actuelles La gestion de l9insuffisance cardiaque chronique est basee sur les recommandations de l9ESC. Dans la plupart des pays, le traitement medical repose sur un examen medical et en depit de l9amelioration des therapies, la plupart des patients atteints d9ICC ne sont pas gere de facon optimale. Les infirmieres sont de plus en plus impliquees dans la gestion de CHF mais ont encore un role limite a la prise de cosntantes et de prelevements. Methodes Nous avons compare en double aveugle la prescription medicale d9une infirmiere formee specifiquement a insuffisance cardiaque (formation specifique sur la maldie, les traitemetns, les bilans et la facon de les interpreter, les recommandations de la societe europeenne de cardiologie, l9utilisation du BNP et de la physiopathologie, l9education des patients) et un cardiologue specialise chez 120 patients insuffisants cardiaques consecutifsen nous concentrant sur l9examen clinique, l9interpretation de la BNP, l9evaluation des traitements therapeutiques et des modifications proposees. Resultats Nous avons inclus 120 patients consecutifs. L9Âge moyen etait de 70.2±5. La FEVG moyenne etait de 32±5%. Le BNP moyen etait de 230±120 pg/ml, la classe NYHA a ete similaire dans 85% des cas. Traitement de l9evaluation a ete similaire dans 89% des patients et 96% des patients sous traitement considere comme optimal par le specialiste en insuffisance cardiaque ont ete identifies comme tels par l9infirmiere specialisee. Les modifications therapeutiques proposees par l9infirmiere HF ont ete confirmes par le specialiste de HF chez plus de 85% des patients et celle-ci a suivi les reciommandations de l9ESC dans 100% des cas. Les differences de prescription entre l9infirmiere et specialiste HF HF sont principalement liees a la spironolactone/antagoniste de l9angiotensine II en association aux IEC. Conclusion Une infirmiere specialisee en insuffisance cardiaque pourrait agir en tant que prescripteur de premiere ligne chez les patients insuffisants cardiaques avec un profil de risque faible.