Clinical Nurse Specialist St. Paul's Hospital, British Columbia, Canada
Background: The goal of heart failure (HF) treatment is to decrease the burden of the disease to improve survival and quality of life. Both pharmacologic therapies and lifestyle modifications have been included as the treatment regimen for HF. The 2017 CCS Guidelines still states targeted restrictions recommendations to both salt and fluid daily intake. Nurses play an integral role in educating patients and caregivers about the importance of HF self-care. With the changes in emerging evidence, we seek to understand current state of HF education across the US and Canada with a focus on salt and fluid restriction. We aim to understand and address any gaps in clinician's perspectives of contemporary evidence related to salt and fluid restriction and whether they are adopting current evidence into practice.
METHODS AND RESULTS: The design is a cross-sectional survey to capture the current institutional practices around sodium and fluid restriction. With ethics approval, the survey was transcribed in the Qualtrics platform and electronically distributed to Canadian and American hospital sites. Specifically, our convenience sample of clinicians invited to participate were associated with the Canadian Heart Failure Society and the American Association of HF Nurses.
Conclusion: The following data is preliminary as recruitment for responses is ongoing. The respondents practiced from a crossover combination of inpatient (49%) and ambulatory (82%) settings. 81% of respondents still routinely educate newly diagnosed HF patients on fluid and sodium restrictions. Sodium restrictions of 1.5-2g/day is still the mostly ordered (48%) and educated (46%) range. For inpatient providers, 35% of them still routinely order fluid restrictions for all HF patients. 36% of the respondents feel current education resources are inadequate for teaching the topics and 44% of them perceived a lack of clarity in the guidelines. 23% of respondents also reported a lack of awareness of existing guidance.
The survey results highlight various knowledge and practice gaps that can be addressed at multiple levels of HF care - from the development of clinical guidelines to the education efforts of bedside educators and practitioners working directly with patients. Acknowledging that many clinicians are still practicing outside of guideline recommendations and addressing these gaps is essential to improving the consistency and effectiveness of HF education across the continuum of care.
