Heart Failure: a community-based diagnostic clinic & service

1. Heart Failure: a community-based diagnostic clinic & service Dr Richard Pile GPwSI in ECHO/Heart Failure

2. Heart Failure – the facts • Syndrome resulting from any structural or functional cardiac disorder that impairs the ability of the heart to function as a pump • 900, 000 people in the UK • 1 in 35 people aged 65-74 • 1 in 7 aged over the aged of 85 • Commonest cause in UK is CHD • 40% die within the first year of diagnosis

3. Heart Failure.. more facts! • average GP looks after 30 patients with heart failure • Diagnosis suspected in >10 new patients per year • Costs the NHS £716 million per year • 2% of NHS inpatient bed days, and 5 % of acute medical admissions • This is going to increase in future

4. Management of Heart Failure • NICE guidance published 2003 • for adult patients with chronic heart failure • aims to symptoms/signs/Ix to establish Dx • also gives guidance on the treatment, monitoring and support of patients with heart failure. • http://www.nice.org.uk/pdf/CG5NICEguideline.pdf

5. NICE algorithm

6. Brain Natriuretic Peptide • BNP is a good test for ruling out heart failure (negative predictive value = 98%) • Testing launched for St Albans and Harpenden practices in June 2004 • Put “BNPS” on form, sample send purple-topped tube, on same day it is taken • Limited uptake so far…spread the word!

7. BNP – the results so far • Definite under-referral, and probable under-diagnosis • PLEASE BE SUSPICIOUS, & REQUEST MORE!

8. Heart Failure diagnostic clinic • GP/PHCT referral as per NICE guidance (see referral form) for newly suspected heart failure • 2 sessions per week, 4 patients per session • Based in SACH Day Hospital • Run by GPwSI and specialist Heart failure nurses • Echocardiography to assess LV systolic function • Counselling re diagnosis and follow up for as appropriate • Immediate feedback (fax or email) and advice re management or further referral

9. Administrative bits… • First session - 29th November • Fax or email referral form • Latter requires emailing from an NHS net address, to the specified NHS net address. • Minimum of important details required • Appointment arranged by clinic clerk and patient contacted • Feedback by fax or email, as requested, by end of clinic • Follow up arranged by heart failure nurses prn

12. Heart failure care pathway - Summary • Heart failure is a common, complex and serious syndrome. • It is difficult to diagnose clinically, and to manage. • We can improve the diagnosis, investigation, management, and outcome for our patients. • There is now a local service to facilitate this, in a primary care/community setting – supporting the patient’s own practice, if required, in managing their heart failure optimally.