Chronic Heart Failure
Supporting improved management of Chronic Heart Failure (CHF) in the community.
About
The Chronic Heart Failure (CHF) program works in partnership with GPs and cardiologists to support their clients within the community.
The program aims to prevent hospital admissions and improve quality of life through self-management education and support delivered by clinical nurse consultants and nurse practitioners. Education topics include CHF management, signs and symptoms of fluid retention, when to seek treatment, and how to minimise exacerbations. Clients are supported short-term and then discharged to a GP and/or private cardiologist.
Services include:
- Self-management education
- Diuretic titration
- Heart Failure clinical review
- Psychosocial needs assessments and referral to allied health or psychologist as appropriate
- Medication optimisation
- Medication review, understanding and adherence, and where appropriate a referral to HOMR is completed
Cost
There is no cost for the Chronic Heart Failure program.
Eligibility criteria
This service is for clients who:
- are over 18 years old and reside in the Monash Health catchment.
- have a Chronic Heart Failure diagnosis
- have had a presentation to ED or hospital admission with LVF, APO or associated symptoms of Chronic Heart Failure
- have an echocardiogram indicating heart failure
- are at high risk of presenting with exacerbation of symptoms of Chronic Heart Failure
This service is not for clients:
- whose primary condition is Hypertrophic Obstructive Cardiomyopathy (HOCM), Amyloidosis or Sarcoidosis
- whose primary condition is renal failure on dialysis, eGFR<15%
- whose primary condition is mental health, alcohol or drug dependence
- whose primary condition is cancer
- who are receiving palliative care
- who are pregnant or post-partum
Referral details
Clients can be referred by:
- clinical staff
- Cardiologists
- GPs
- self
Referrals should be sent by eReferral through Healthlink, by email or by calling Community Access at (03) 8572 5631. Please include all patient demographic and clinical details as well as relevant investigation results.
Phone:  (03) 8572 5631
Email: icareaccess@monashhealth.org
For more information about access to community-based services
Help contacting us
For people who need help with English or an interpreter: : TIS:Â 131 450
For people with hearing or speech loss: TTY:Â 1800 555 677
Speak and Listen:Â 1800 555 727
Internet relay: National Relay Service:Â www.relayservice.gov.au