Telemedicine Helps Improve Access to Care for Patients With Heart Failure

Nurses as a Key Part of the Team

Prof. Krejčí considers nurses to be “one of the most important components” of any medical team. In cardiology, he says, their specialization allows them to take over many responsibilities typically performed by physicians. For example, they can often “recognize alarming signs of impending decompensation of heart failure and either independently or in cooperation with a doctor adjust medication.” In intensive care units, cardiac nurses can also modify vasopressor dosing, helping physicians manage complex cases more efficiently.

Prof. Krejčí supports the creation of an appropriate legislative framework that would allow for greater involvement of nurses in the care of cardiology patients. He also suggests introducing a specific reimbursement code for nursing interventions that would reflect their contribution on a financial level.

Legislation Should Reflect Clinical Practice

From the nursing perspective, Mgr. Černá also points out limitations in the current scope of nurses’ competencies, which prevent them from fully utilizing their potential. In practice, this often leads to delays and complications in care continuity. As an example, she mentions repeated consultations with physicians even in cases where nurses could decide independently based on clearly defined protocols.

She believes legislation should “better reflect real-world practice and allow nurses greater autonomy in decision-making processes that they already competently manage in everyday clinical work.” One of the greatest advantages of her specialization, she says, is the ability to actively participate in team decision-making.

The head nurse welcomes the expansion of competencies in the care of patients with heart failure thanks to a certified training program. Nurses who complete the course can monitor and titrate pharmacotherapy, educate patients, identify and triage decompensation, and coordinate care transitions between inpatient and outpatient settings.

Monitoring Patients Remotely

Nurses are also playing an increasingly prominent role in telemonitoring. The implementation of telemonitoring in practice was one of the topics of the first nursing session at the October conference of the Czech Heart Failure Association.

“This field offers new opportunities to monitor patients remotely, improving access to care and enabling timely responses to changes in health status. It also emphasizes patient education and interdisciplinary cooperation, which I consider essential for the further development of modern cardiac nursing,” says Mgr. Černá.

According to her, it is often the nurses who “evaluate transmitted data on a daily basis (e.g., blood pressure, heart rate, body weight, presence of edema, dyspnea) and identify warning trends.” “They are the first point of contact for patients when irregularities occur and coordinate next steps with physicians as needed. They also play a key role in educating patients on how to use the system correctly and what parameters to monitor,” she adds.

Access to Care for All

Telemonitoring can take different forms depending on patient access—from simple phone check-ins to data entry in an app accessible to doctors, or fully automated transmission from smart or implanted devices.

More sophisticated systems, such as CardioMEMS, have shown about a 30% reduction in costly hospitalizations for heart failure. They use a pulmonary artery pressure sensor (reacting to changes in pressure or inferior vena cava size as a sign of fluid retention), allowing early detection of clinical deterioration.

“But even simple methods, such as monitoring weight or heart rate, can help recognize early signs of worsening—and if we respond by adjusting medication, hospitalization can be avoided,” notes Prof. Krejčí. He also sees potential for telemonitoring in arrhythmias, where devices like smartwatches can detect atrial fibrillation, and in hypertension. By remotely transmitting INR values, patients can also support anticoagulant dose adjustments from home.

According to Prof. Krejčí, combining greater involvement of cardiac nurses with telemonitoring could be the key to improving access to cardiovascular care, as heart failure clinics are unevenly distributed across the Czech Republic. “Projections show that the number of cardiovascular patients will continue to rise, while the number of physicians likely will not. Shifting part of care to telemedicine could help balance this disparity,” he concludes.

Editorial Team, Medscope.pro