Increasingly patients with severe heart failure are managed in the community by specialist heart failure nurses working with primary care and cardiology teams. Their input is crucial, they’re often in the best position to detect early signs that the condition is worsening and to act to prevent acute exacerbations. Given that renal and heart failure share many features, indeed death from heart failure or renal failure rarely occurs in isolation, there is a real opportunity to develop, commission and deliver conservative kidney care and heart failure services together.
The heart failure framework complements the kidney care approach, there is a particular focus on advanced care planning and the importance of multi-disciplinary working including social care is emphasised. The recent release of information about the place of death of people dying from kidney disease , with the majority dying in hospital, compared to cancer related deaths where the majority get to die in their own homes or hospices, may also signify inadequate Local Authority and social care provision in conservative kidney care.