Leeds Integrated Heart Failure Service

Aim of the Service

The Leeds Teaching Hospitals Integrated Heart Failure service aims to provide specialist support for all patients living with Heart Failure.

You may have just received your diagnosis of heart failure or you may have been living with the condition for many years.

Our goal is ensure that you receive excellent evidence based treatment and care that is tailored to your individual needs.

What is Heart Failure

Heart Failure is an umbrella term but can be caused by different conditions that affect the performance of the heart.

Heart Failure can be a frightening term if you are unfamiliar with it. It does not mean your heart is going to stop. It can be useful to think of it as ‘my heart is not functioning as well as it should’.

Regardless of the cause or type of Heart Failure, patients experience similar symptoms such as; breathlessness, fluid retention and fatigue. The degree of symptoms varies from person to person.

It can be helpful to understand the type of Heart Failure you have and what has caused it. We will always try to address this, but it is not always possible to find a cause.

Most patients are diagnosed from their clinical assessment and undergoing an Echocardiogram. This is an ultrasound of your heart. The type of Heart Failure you have will determine what, if any, additional investigations you may require. It will also determine what medications we offer you and what follow up you will need – this is discussed later on.

For further information about Heart Failure, symptoms, medications, lifestyle advice and support groups we recommend the following resources:

Pumping Marvellous Tel: 01772 796542

British Heart Foundation Tel: 0300 330 3322

The Team

We believe a multidisciplinary approach to Heart Failure provides the highest standard of care.

Our team is made up of Consultant Cardiologists, specialist nurses, specialist cardiac scientists, cardiac physiologists and other allied health professionals.

The multidisciplinary approach allows us to provide specialist, comprehensive and co-ordinated care.

The hospital based Heart Failure team work in conjunction with the community Heart Failure nursing teams, aiming to provide seamless care between hospital and community settings.

The community Heart Failure nursing team in Leeds are currently only commissioned to see patients with a certain type of Heart failure, known as reduced ejection fraction. You may not be able to access this service depending on your diagnosis.

Attending the Heart Failure Clinic

Depending on the stage of your diagnosis and treatment you may require some additional tests on the day prior to seeing the doctor. Most commonly these included;

• Electrocardiogram (ECG) to assess the rate, rhythm and electrical activity of your heart. This only takes a few minutes. You will need to undress to your waist and the physiologist will place stickers across your chest, arms and legs and attach electrodes to the stickers.
• Echocardiogram commonly referred to as an Echo. This is an ultrasound that looks at the structure of your heart as well as how the muscle and pumping function is working. You will be asked to undress to your waist and lay down. This time this takes can vary but usually takes up to 30 minutes.

Types of Heart Failure

As previously mentioned there any different types of Heart Failure, the Echocardiogram and your past medical history usually allow us to explain which type you have.

This is usually based on the Echocardiogram results. Your doctor or nurse may talk about Ejection Fraction (EF). EF is a measurement of how much blood is pushed out of your left ventricle each times it contracts and is expressed as a percentage. A normal EF is around 50-65%.

Generally speaking we can categorise Heart failure into 3 types;

Heart Failure with Reduced Ejection Fraction

This is often referred to as left sided Heart Failure. It means that your EF is <40%.

If you have this type of Heart failure there is a very strong evidence base for the use of 4 different medications to support the pumping function of your heart, control symptoms (make you feel better) and help you avoid admission to hospital and reduce your risk. Your doctor or nurse will talk to you more about these medications at your appointment. They are often referred to as the four pillars of Heart Failure treatment.

If you have been diagnosed with this type of Heart failure you will likely require additional follow up appointments with the heart failure specialist nurses. This is to enable us to get you on as many of the four recommended medications as possible. The Heart Failure nurses have teams in both the LGI and the community. In some cases this can be done by your GP.

Heart Failure with Mildly Reduced Ejection Fraction

This means that your EF sits between 41-49%. In this case your treatment will be based on your individual needs. Your doctor or nurse may suggest additional medication depending on condition and symptoms.

Heart Failure with Preserved Ejection Fraction

This means that you have a normal EF >50% but you are still experiencing signs and symptoms of Heart Failure because of a structural or functional abnormality of your heart. This can be due to problems with your right ventricle, the valves or that your heart does not relax normally after contracting.

There are not as many medications for this type of Heart failure but your doctors and nurse will focus of managing any symptoms you may have and also review factors that may be contributing to your condition such as high blood pressure.

Why Have I Been Discharged from the Heart Failure Clinic?

In most cases Heart Failure is a chronic condition which is often characterised by periods of stability.

The role of the Consultant clinic is to determine the cause of your Heart Failure (if able), arrange any additional tests that may be required and consider any specialist treatment you may need in addition to medication.

Once these issues have been addressed you are likely to be discharged from the clinic. You may be referred to, or continue seeing a specialist Heart Failure nurse to manage medication changes or to help you manage any unstable symptoms.

If you have a pacemaker you will continue to have regular appointments with the pacemaker department.

We may feel you no longer require our specialist input and we will discharge you back to the care of your GP. Having a diagnosis of Heart failure means that you should be seen by your GP in a Long Term Conditions Review. Ideally this should be every 6 months.

You are able to be referred back into the Heart Failure service at any time should your condition change.

You can do this yourself by contacting the heart failure nursing team based at the LGI or the Community Heart Failure service if you were previously seen by them. They will ask you some questions about your condition to determine what input, if any, you need.

Both services are available Monday – Friday.

Alternatively you can seek help from your GP. If they feel you need specialist Heart Failure input they can refer you back to our service.

How do I Know When to Seek Help?

The following is a tool to help you assess your symptoms and when you should seek help and advice.

We want you to seek help when your symptoms have changed from what is ‘normal’ for you.