Heart Failure

 

Heart failure (HF) is a condition that means that the heart is unable to pump blood around the body properly, usually because the organ is pumping weakly or has become stiff. It’s caused by a range of problems, such as previous heart attacks, high blood pressure or heart valve problems although there are many rarer causes too. Sometimes the underlying cause is unknown. The most common symptoms reported are shortness of breath, tiredness, and accumulation of fluid with swollen ankles, feet or abdomen.

The Royal Devon & Exeter multi-disciplinary team consists of two consultant cardiologists, and a HF Specialist Nursing Team comprising of a lead nurse, two inpatient nurses and a team of community-based nurses. We work alongside numerous healthcare professionals including pharmacists, physiotherapists, occupational therapists, and the palliative care team to together ensure that patients with Heart Failure receive the best care and treatment both in hospital and at home.

More on what we do

Patients are carefully assessed and a management plan is put in place to help you manage your condition and to optimise your quality of life, through medication, device interventions and changes in lifestyle.

We'll monitor you and help you to feel more in control of your diagnosis and manage symptoms.

The team at Royal Devon & Exeter will work with you, your GP, and other speciality doctors across the hospital to make sure your heart failure is optimally managed in combination with any other long term health conditions.

Treatments

The overriding aim of our service is to treat your condition to enable you to live well with heart failure.

We offer the full spectrum of evidence-based heart failure management including medication therapy, cardiac device therapies e.g. cardiac resynchronisation and defibrillators, surgical and valve intervention techniques and heart transplantation and mechanical heart support with partnerships at Cardiac Surgery and Cardiac Transplant centres nationally.

We are an active research centre, in partnership with the University of Exeter and other national research bodies, which offers those patients who wish to participate the opportunity to enrol in trials of new potential therapies for Heart Failure. We will adjust your heart failure medication therapy to improve your symptoms and quality of life. We can offer advice on lifestyle issues such as healthy eating, exercise, managing your medications, activity and how to stop smoking. We advocate self-management strategies to empower you to feel in control of your condition.

The team also offers a structured six-week educational programme and support group called ‘Heart to Heart’ for patients (and carers) in collaboration with our colleagues at Hospiscare Exeter. Sessions include:

Sessions include:

  1. What is heart failure?
  2. Recognition of worsening symptoms
  3. Self-management strategies
  4. Advice and Education - diet, exercise and managing breathlessness
  5. Emotional difficulties of living with a long term physical condition
  6. Thinking about your future wishes

These sessions are delivered by the wider multi-disciplinary team: including Hospiscare nurses, physiotherapists, dietitians and occupational therapist and practitioners from Talkworks (Talking Health Team). Relaxation techniques and complementary therapy are also available.

In the future we aim to offer a personalised exercise-based cardiac rehabilitation programme for all patients diagnosed with heart failure.

If you have questions about your condition, or if you experience deterioration in your symptoms, the team are on hand to help.

Our team

We are one team providing HF specialist care throughout the patient journey whether they are inpatient or in the community.

Consultants

  • Dr Andrew Ludman - Consultant Cardiologist
    Dr Ludman has a specialist interest in Heart Failure, Cardiomyopathy and Advanced Cardiovascular Imaging (MRI, CT an echocardiography). In addition he is the Clinical Lead for Cardiology at Royal Devon & Exeter Hospital NHS Foundation Trust.
  • Consultant Cardiologist - Dr Benjamin Dyer
    Dr Dyer has a specialist interest in Heart Failure and Cardiac Devices (the implantation and use of pacemakers, cardiac resynchronisation therapy and defibrillators for the benefit of patients with Heart Failure, and Heart Rhythm problems).

Clinical Nurse Specialist Lead of the Integrated Heart Failure Nursing Service

  • Lisa Lovedale

Inpatient Heart Failure Nurse Specialists

  • Sarah Jelf
  • Lisa Brown

Their role is to aid prompt diagnosis for patients admitted suspected as having heart failure, assist with management plans for these patients, provide reviews as needed, and recommend best place for care, which will often be on one of our cardiology wards. They will offer patients with confirmed heart failure, information about their condition, education, self-management strategies, psychological support and symptom management advice. It is also useful to inform the inpatient nurse specialists of admissions due to other causes of any known heart failure patients, as sometimes these patients go on to need further management whilst they are in hospital.

In addition to their clinical work, the inpatient nurses are planning to develop their educational and teaching role for colleagues and other healthcare professionals. We have a robust system in place for patient care to be handed on to the community nurse specialists once patients have been discharged from hospital. All the nurse specialists meet weekly to discuss patient management, and to decide which healthcare professional is best placed to provide follow up care to patients once they are home. Most patients will have follow up care with the community nurse specialists, though some will be optimally managed by their GP or community matron

Community Heart Failure Nurse Specialists

  • Cherry Vinnicombe
  • Debbie Beales
  • Kelly Thomas
  • Cate Passmore
  • Lisa Lovedale - lead nurse, predominately community based

The community arm of the team follow up patients after discharge, and also receive referrals from Cardiologist outpatient clinics and GPs. Follow up is via a combination of phone consultations, clinic appointments and home visits, depending on patient need. Similarly to the inpatient nurses, education, advice, psychological support and self-management strategies are offered to patients.

A significant aspect of their role is management of a patient’s symptoms (breathlessness, fluid retention, fatigue) and to optimise their medication. Adding and increasing medications needs to be done gradually so it’s likely that patients will have regular visits for a few months. Each nurse has their own caseload of patients which means that you will usually see your own nurse each time. Patients have access to a telephone message line so they can contact their nurse for advice and support. We collaborate with GPs, community nurse teams and matrons, and palliative care.

We run a multidisciplinary team meeting monthly, attended by the Cardiologists and the Inpatient and Community heart failure specialist nurses, at which we can discuss more complex cases.

Where to find us

RD&E Wonford, Barrack Rd, Exeter EX2 5DW

We are based at the RD&E Hospital Wonford and also at community sites throughout the wider area.

The cardiology inpatient wards are Avon, Taw and the Coronary Care Unit, however we contribute to the care of Heart Failure patients throughout all inpatient areas of the hospital.

Consultant Heart Failure clinic appointments take place at: Medical Outpatients, Main Entrance, RD&E Hospital Wonford.

Heart Failure Nurse Specialist Clinics take place at a number of community sites across the wider area and additionally within patients’ homes, where clinically indicated.

The Inpatient Heart Failure Nurse Specialists’ office is located in Cardiology Area Q, level 1, Room Q117 at RD&E Wonford.

The Community Heart Failure Nurse Specialists are based at Newcourt House, Old Rydon Lane, Exeter EX2 7JU.

Contact us

The heart failure nursing service is available weekdays. You can contact us during office hours, Monday to Friday, 9am-5pm.

Inpatient Heart Failure Nurses

Telephone: 01392 403818 - you can also contact them via the operator of the RD&E switchboard on 01392 411611

Contact us for any referrals, queries, or advice or information about patients who are currently inpatients.

Community Heart Failure Nurses

Telephone: 01392 356159

The nursing team are often out in the community doing clinics and home visits so PLEASE leave a short message including name and contact number on our voicemail. We will return your call as soon as possible but please note this might not be the same day. If it is very urgent - please contact your GP or the out of hours services.

Patient leaflets and documents

Children and young people

We provide a specialist Heart Failure service for adults, but we provide additional assistance for those young people with a Heart Failure diagnosis transitioning to the care of the Adult cardiology service, in conjunction with our paediatrician colleagues.

Clinics

Click on a site to visit the 'Our sites and getting here' information. 

Royal Devon & Exeter Hospital - Multiple clinics weekly

Exeter Community Hospital - Multiple clinics weekly

Honiton Hospital - Weekly clinics

Ottery St Mary Hospital - Weekly clinics

Tiverton Hospital - Weekly clinics

Crediton Hospital - Weekly clinics

Sidmouth Hospital - Weekly clinics

Okehampton Hospital - Bimonthly clinics

Exmouth Hospital - Weekly clinics

Budleigh Hub Hospital - Bimonthly clinics

Information for healthcare professionals

The main referral pathway for suspected Heart Failure in the community is via NT-proBNP and open-access echo (NT-pro-BNP > 400 pg/ml).

Referrals to Community Heart Failure Specialist nurses are via email to rde-tr.heartfailurereferrals@nhs.net.

Please only refer patients with a CONFIRMED diagnosis of heart failure (echocardiogram or cardiac MRI), and provide relevant medical history, medications and ECG. 

GP referrals may be discussed at the MDT if they are not already known to a Cardiologist, prior to being seen by the HF community nursing team.

RD&E inpatients – please refer all suspected or confirmed Heart Failure diagnoses to the inpatient HF nurse specialists via the RD&E Whiteboard, via bleep 346, or via extension x3818.

The Heart Failure team Multi-disciplinary Team meetings are held monthly at the Royal Devon and Exeter Hospital – if you would like your patient to be discussed in this forum – you (GP or other healthcare professional) would be very welcome to join the meeting.

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