Heart failure services in North Central London
Introduction
Heart failure is a clinical syndrome characterised by symptoms such as breathlessness, fatigue and fluid retention. It is caused when the heart is unable to pump enough blood fast enough to meet the needs of the body. Most cases are due to coronary heart disease and damage following a heart attack. Heart failure affects 900,000 people in the UK and is particularly prevalent among older people.
The condition accounts for about 5% of all medical admissions to hospital, and rates of re-admission are also among the highest for any common condition in the UK. Providing services to patients with heart failure costs the NHS an estimated £625 million each year. Research indicates that care provided by effective multidisciplinary teams can have a positive impact on outcomes for patients and their quality of life (Healthcare Commission 2007) and this is one of the recommendations of the most recent NICE Guidance (August 2010).
The North Central London Heart Failure Task Group was established with the aim of developing heart failure services within the Cluster. Membership of the task group consists of HF clinicians (GP's, consultants and nurses), palliative care clinicians, commissioners, public health experts and managers. The priorities for the Group this year are the continued monitoring of prescribing patterns in secondary care, the reduction of re-admissions for heart failure, increasing the uptake of BNP testing before referral for echocardiogram, the introduction of patient surveys to measure patients’ perceived quality of life and the redesign of services to provide a model of multi-disciplinary care that improves outcomes for patients.
Progress against outcomes
- So far this year there has been an improvement in prescribing in secondary care trusts with an increase in the numbers of patients being discharged on the correct medication. Monitoring is continuing to see if this is having an impact on re-admissions for patients with heart failure.
- GPs across the Cluster have been informed of the requirement to request a BNP test before referral for an echocardiogram and this has resulted in increase in the uptake of BNP tests by GPs and a decrease in first outpatient appointments and echocardiograms.
- An integrated, consultant-led, multi-disciplinary service is being implemented in UCLH, initially for a trial period. This will be a ‘one-stop’ shop, with new patients having an echocardiogram and specialist assessment on the same day. Secondary care clinicians and community heart failure specialist nurses will work together to ensure that patients are receiving care that is appropriate to their needs and avoid duplicating appointments. The redesigned service will be operational from the first week of April 2012.