The potential of nursing to reduce the burden of heart failure in rural Canada: what strategies should nurses prioritize?

Chronic heart failure (CHF) is an increasingly common condition in high-income countries that has a large and negative impact on life quality and expectancy, and is associated with high financial costs. In Canada, CHF has an especially large impact on rural settings because of the higher proportion of older adults (aged >65 years) in these settings, and because care and outcomes tend to be more adverse in rural parts of the country compared to urban settings. Much can be done to reduce these burdens in terms of pharmacological, behavioural and health service strategies. However, rural patients tend to have worse care and outcomes than urban patients. Realizing the benefits of these strategies in Canada's rural settings requires consideration of underlying reasons for poor care and outcomes. We propose the main reasons for adverse outcomes are related to the nature of CHF and the combined influence of demographics, health services and the rural context. Nurses remain under-used in CHF management in Canada and can play a vital and influential role in reducing the burden of CHF in rural settings. To increase and improve nurses' roles, we recommend that nurses should support the development and adaptation of disease management programs in rural settings and promote the centrality of nursing in these programs. Nurses in or working with rural settings should seek to support and use tele-health technologies effectively and provide better support to lay caregivers. It will also be vital to increase the nursing capacity regarding specialist roles for CHF management.