Feature Report

Heart failure specialist nurses across Europe – Gaps, potential and opportunities

What are heart failure (HF) specialist nurses?

HF specialist nurses are fully qualified nurses with specialist knowledge and advanced skills to treat, manage and care for people with HF.

How can they benefit people with HF?

HF specialist nurses play a vital role in the multidisciplinary care team, acting as a key contact for patients and offering much needed continuity of care across their entire care pathway.

They have been shown to benefit patients in a number of ways:

  • They offer support to patients when they are discharged from hospital – providing smoother transitions back into the community.
  • They provide ongoing follow-up care to patients within their own homes through regular monitoring and tailored education to patients and their families to enable self-care.1
  • When needed, they can assist individuals reaching end-stage HF by acting as care coordinators2 and referring patients onto specialist palliative care services.1

What does the evidence say?

  • Nurse-led interventions have been shown to reduce hospital admissions for HF patients.1 3
  • HF specialist nurses have been shown to enhance HF patients’ quality of life and adherence to treatment.1
  • Greater investment in HF specialist nurses is likely to be cost-effective in the long-term4 – as has been shown with other conditions such as cancer, diabetes, Parkinson’s disease and epilepsy.4

What is the current situation across Europe?

Unfortunately, HF specialist nursing roles are poorly developed across Europe and a number of barriers exist to changing this situation.3

  • In most countries, there are no requirements for local hospitals or GPs to provide HF specialist nurses and therefore many patients do not have access to such services. For example, in England, HF specialist nurses have been largely supported by charities and independent funders. 1
  • HF specialist nurses are often not offered any additional remuneration for their role. For example in Belgium, this remuneration is left to the discretion of individual hospitals. Similarly in France, nurses working in the community (infirmiers libéraux) may provide therapeutic education and follow up to HF patients on an informal and voluntary basis, however they do not receive any formal reimbursement for these roles.5
  • Training courses are not readily available, and there is often no single accreditation for HF specialist nurses.
  • In some countries, nursing roles in general are poorly developed. For example, Bulgaria for example has a very low proportion of nurses compared to the EU average.6 Primary care nurses are also not readily available in GPs are usually the ones managing HF patients in the community, however they do not have the resources to do so proactively.7

What is needed?

Greater investment in HF specialist nurses – or at least, nurses with training in HF – is urgently needed to ensure patients receive multidisciplinary and person-centred HF care:

  • First and foremost, HF specialist nurses must be officially recognised as a profession and their roles formalised through professional codes and specific remuneration appropriate to the professional structure of each healthcare system
  • Nationally accredited training courses need to be developed
  • Official care coordination roles for HF specialist nurses within multidisciplinary teams should be created
  • HF specialist nurses should be included in hospital discharge plans as the dedicated contact for patients when they leave hospital.



  1. Price A. Specialist nurses improve outcomes in heart failure. Nursing times 2012;108(40):22-4.
  2. NHS Improving Quality. End of life care in heart failure: A framework for implementation Leeds: NHS Improving Quality 2014.
  3. Strömberg A et al. Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failure. European Heart Journal 2003;24(11):1014-23.
  4. Royal College of Nursing. RCN Factsheet: Specialist nursing in the UK. London: RCN, 2013.
  5. Poyet L. Infirmière libérale : consultation d’éducation thérapeutique pour l’insuffisant cardiaque. Ifsi Clermont-Ferrand, 2013.
  6. Dimova A, et al., editors. Health systems in transition: Bulgaria health system review European Observatory on Health Systems and Policies 2012.
  7. Cancian M et al. The care for chronic heart failure by general practitioners. Results from a clinical audit in Italy. Eur J General Practice 2013;19:3.
  • Price A. Specialist nurses improve outcomes in heart failure. Nursing times 2012;108(40):22-4.