Case study from Heart failure policy and practice in Europe

Nurse-led management of heart failure medication

17 November, 2020

A recent trial (Enfermera Titula Fármacos en Insuficiencia Cardiaca, ETIFIC) compared the safety and effectiveness of nurse-led and cardiologist-led adjustment of medication following hospitalisation for people with heart failure with reduced ejection fraction (HFrEF).1 The trial included 20 hospitals with heart failure units across 10 regions in Spain. Nurses were required to have at least 400 hours of heart failure training and 2 years of clinical experience in heart failure to lead the intervention.1 While cardiologists prescribed medication and provided routine supervision, nurses led weekly or fortnightly visits with participants to monitor and adjust medication, evaluate clinical status and provide therapeutic education.

The study found that medication adjustment was equally safe and effective whether led by nurses or cardiologists.1 Participating centres are continuing to provide the service after the end of the trial, and other hospitals have adopted the same care model.2 Formal endorsement of the service by regional health authorities is still lacking, but there are plans to incorporate the ETIFIC training criteria for heart failure nurses into national standards for heart failure units developed by the SEC.


  1. Oyanguren J, García-Garrido L, Nebot-Margalef M, et al. 2020. Noninferiority of heart failure nurse titration versus heart failure cardiologist titration. ETIFIC multicenter randomized trial. Revista Española de Cardiología (English Edition):
  2. García-Garrido L. 2020. Interview with Marissa Mes at The Health Policy Partnership (Secretariat for Heart Failure Policy Network) [written interview]. 03/08/20
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The Heart Failure Policy Network is an independent, multidisciplinary platform made possible with financial support from AstraZeneca and Roche Diagnostics. The content produced by the Network is not biased toward any specific treatment or therapy. All outputs are guided and endorsed by the Network’s members. All members provide their time for free. The Network is hosted by The Health Policy Partnership .