The Transitional Heart Failure Clinic is an outreach service that provides care to patients in their homes.
Tel: 902- 240-5267 available during clinic hours only
The Transitional Heart Failure clinic (THFC) provides home-based care to frail patients with heart failure who are approaching the end of their life. The main goals of patient care are to control symptoms, maximize function, maintain quality of life and reduce admission to the Emergency Department and to the hospital. This clinic service is provided by a nurse practitioner and a group of physicians from Internal Medicine, Geriatrics & Palliative Care.
The Transitional Heart Failure Clinic is a specialty service. Patients who are frail and are living with end-stage heart failure must be referred from a Specialist clinician from the Nova Scotia Health Authority. At this time the clinic can provide service to patients who live within 35Km from the QEII Health Sciences Centre. You are not required to have a Family Practitioner in order to be accepted to the THFC service.
Patients who are referred to the Transitional Heart Failure Clinic will be contacted by the clinic nurse practitioner to schedule their appointments. It is most helpful to have a family member or your next of kin available for at least the first appointment. To prepare for your appointment, please have the following:
Below are questions that you may want to ask at your first appointment.
You will be visited by a Nurse Practitioner (NP) in your home. The NP may also be accompanied by a THFC doctor. The first visit will be a minimum of 2 hours and will involve gathering information and reviewing your current overall health needs, symptoms, supports and goals for your care. The main goal will be to reduce symptoms of heart failure and begin to develop an Advanced Care Plan for you that is in keeping with your goals for care.
At the first visit and at each follow-up visit, the NP will review your questions, concerns, and symptoms of heart failure, medication, record of weight, available supports and Advanced Care Plan. The NP will also take your pulse, blood pressure, listen to your heart and lungs and check for signs of heart failure (i.e. swelling). The NP will adjust medication based on all of this information and help to put supports in place for you and your family in order to address your health needs, improve your symptoms and your quality of life.
Some patients may require intravenous (IV) medication to help improve their heart failure signs and symptoms. This can be provided by the NP or by Continuing Care and this can be arranged by the clinic NP.
Following each visit The NP will provide a letter to your family practitioner detailing a plan of care and a plan for follow-up.
The NP will schedule follow-up visits based on your signs and symptoms of heart failure and your need for ongoing management and support. Patients will be encouraged to call the clinic if their signs/symptoms of heart failure worsen so that they can be booked for follow-up more urgently if needed.
Heart failure is a progressive disease and as patients move to end of life, palliative care will be consulted for ongoing support in order to facilitate your goals of care and comfort.
The Transitional Heart Failure Clinic is an outreach service that provides care to patients in their homes.
Tel: 902- 240-5267 available during clinic hours only