November 20, 1998

Walter Netto's face lights up when Dottie Noyes walks into his hospital room on Ellison 10. Noyes is not a family member, but she has been helping Netto through a tough time. Noyes is a clinical nurse specialist, who administers the heart failure pathway for patients like Netto who have severe heart problems.

Netto has arrhythmia, which is an irregular heartbeat, and was recently hospitalized with a severe episode associated with his condition. The pathway to which Netto has been assigned helps address the consistency of care for heart failure patients, who often present challenges because of the complexity of their chronic illness.

Noyes manages heart failure patients by providing in-depth physical assessments, education about their illness and advice on lifestyle modifications such as dietary restrictions and activity or rest recommendations. Caregivers of patients on this pathway also may include a staff cardiologist as well as a general internist or primary care physician.

Once Netto leaves the hospital, he will continue to be cared for by cardiac home care nurses in consultation with an advanced practice nurse.

According to Thomas DiSalvo, MD, of the MGH Cardiac Unit, data from this pathway also has shown that involving cardiologists in the patients' care may help reduce readmissions. And because physicians can entrust their patients' home care to highly-specialized nurses, patients may be able to leave the hospital sooner.

"The complex, chronic nature of heart failure has a tremendous impact on the use of health care resources and a patient's quality of life," says DiSalvo. "Having a consistent expert educating the patient and family, plus involving a cardiologist in the care as appropriate, has improved the care of this traditionally difficult-to-monitor patient population."

Dottie Noyes, RN, and Walter Netto