Heart failure: Improving diagnosis and reducing re-admissions

A HSJ Award-winning heart failure pathway transformation project.

Heart failure is a serious long-term condition that usually gets gradually worse over time. There is currently no cure – unless there is a curable underlying condition – but the symptoms can often be managed successfully for many years, particularly if diagnosed early.

However, most cases of heart failure are diagnosed too late.

In the UK, 8 out of 10 people receive a heart failure diagnosis in secondary care or during an emergency, while more than 40% will have reported possible symptoms during GP or other primary care consultations as early as five years prior.

Creating a more integrated pathway

Imperial College Heath Partners’ (ICHP) healthcare pathway transformation service is designed to support the NHS to identify opportunities to improve patient outcomes and accelerate pathway transformation.

In July 2020, a co-design team was formed, with representation from Imperial College Healthcare Trust (ICHT), North West London Integrated Care System (ICS), and AstraZeneca, to create a more integrated pathway for heart failure in North West London (NWL), reduce unplanned heart failure admissions, improve efficiency and patient experience, and outcomes.

Establishing the extent of the challenge

To begin the team turned to the real-world data contained within the Discover dataset to assess the extent of the challenge. This enabled the team to map the pathway for patients with heart failure, establish how often they were presenting to healthcare services and associated costs, as well as patient outcomes.

The data highlighted that, on average, survival time for those diagnosed with heart failure within the community was ten months longer than those diagnosed in a hospital, and the cost of caring for patients diagnosed in hospital was also shown to be significantly higher than those diagnosed within the community.

Using real-world data to assess potential benefit

The real-world ecosystem provided by the Discover dataset was then used to assess the potential effectiveness of two different technologies – EkoDuo and Luscii – alongside several other pathway improvements, including recruiting more specialist heart nurses to reduce waiting times and strengthening data capture to improve efficiency.

The study had indicated that life expectancy post-diagnosis for patients diagnosed in the community is ten months longer than that of patients diagnosed in hospitals. Therefore, EkoDuo, a digital stethoscope with the ability to run the same assessment as a 12-lead ECG, was introduced as a screening tool within primary care. Using EkoDuo to divert 90% of patients into the community pathway instead of hospital, has the potential to save the equivalent of 246 life years. This is because it would allow GPs to better predict a patient’s risk of heart failure at an early stage and refer them for further assessment and treatment.

Luscii remote patient monitoring, which allows patients in the early stages of heart failure to record their weight and blood pressure via Bluetooth daily, was found to have the potential to reduce re-admissions by up to 25%. Nurses monitoring the data are trained to spot concerning trends and intervene rapidly to prevent the patient’s health deteriorating any further, and avoid hospital readmission. This technology has now been adopted and around 100 patients in NWL are using it to monitor their condition.

Finally, the study concluded that a combination of the two technologies, together with the other relatively simple pathway changes, could save £27.4m a year in NWL alone.


An award winning partnership

The project won both HSJ awards it was nominated for: the Primary and Community Care Innovation of the Year Award and the Digitising Patient Care Award.

The HSJ Awards recognise sharing best practice, improving patient outcomes, and innovating drivers of better service continue to be the most esteemed accolade of healthcare service excellence in the UK.

We thank Dr. Carla Plymen​, FRCP, FESC, FHFA, Consultant Cardiologist​, Heart Failure Lead, Imperial College Healthcare Trust; Dr. Afsana Safa, MRCP, MRCGP, DRCOG, DCCM ,GP, Marylebone Health Centre, Clinical Director, West End & Marylebone Primary Care Network, GP Federation, Healthcare Central London; Dr. Simon Gordon Former IT Lead- Central London CCG, and Carys Barton, Heart Failure Nurse.


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