LAUSR

Along with an evolving armoury of pharmacological agents and devices, predominantly nurse-led heart failure (HF) management programmes represent important cogs in the wheel of effective management of patients hospitalized with the syndrome.1 Indeed, if we were to take the analogy further, we could argue that these programmes represent the ‘lubricant’ that ensures that each cog of effective HF management (including the health professionals who deliver care) work smoothly together and for the best interests of the patient. It’s now been 20 years since the formative randomized trials of HF management (of varying types) were conducted and more than a decade since a definitive systematic review and meta-analysis of the available evidence confirmed that the application of multidisciplinary programmes was associated with both reduced risk for rehospitalization and prolonged survival in hospitalized individuals.2 Remarkably, however, the application of post-discharge HF management programmes remains inconsistent and their inherent value has been questioned. This scenario defies expert recommendations for their routine application and a plethora of systematic reviews and meta-analyses that are consistently positive overall,3 whilst noting the consistent inconsistency of evidence to support the application of remote management techniques.3,4 In reality, the translation of evidence in favour of HF management programmes has been complicated by a number of persistent issues that have both shaped and impeded their application. Firstly, the nomenclature used to describe the overall nature and components of HF management programmes is both broad and inconsistent.