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Innovative heart failure pathway saving lives and lowering hospital admissions

Heart failure is a condition that is associated with high mortality and hospital admission rates in the UK and puts significant stress on NHS services. In fact, heart failure takes up 2% of the annual NHS budget.

Historically the process to accurately diagnose heart failure and put patients on the correct treatment has been a lengthy one.

Now Dr Aaron Wong, Consultant Cardiologist at the Princess of Wales Hospital in Bridgend, is changing the way potential heart failure patients are managed, leading to timely diagnosis and treatment and a reduced risk of further admission to hospital.

There are many evidence based heart failure medications that have been shown to improve patients’ symptoms, reduce their risk of readmission and reduce mortality. However, timely diagnosis and treatment are key to improve outcome in these patients.

Around one million people in UK have a diagnosis of heart failure and 65,000 patients are hospitalised with the condition each year. The prognosis of heart failure is worse than majority of cancers with a five years mortality rate of 50%.

Heart failure does not just affect longevity of life, but also affects the quality of life of patients to a great extent. The common heart failure symptoms are breathlessness, tiredness, limbs swelling, poor sleep, and reduce appetite etc.

Dr Wong explained, “The path to diagnosis and acute care for heart failure patients has always been challenging in this country.  When you compare it with cancer treatment for example, it will take a heart failure patient longer to get the necessary tests done and be put on the correct treatment pathway. We have changed that method considerably which has meant a far better prognosis for our patients.”

Historically, diagnostic and treatment pathways have been long for heart disease patients. On average, 6-12 months is needed to get the diagnosis and maximise evidence-based drug treatments. Dr Wong has revolutionised this process.

Dr Wong prioritises patients based on their clinical features and a blood tests called NTproBNP (the higher the level, the worse the symptoms and prognosis). Patients with high level of NTproBNP are prioritised to attend a one-stop heart failure clinic within two to three weeks. Heart scans, tracings, X-rays, blood tests and clinical consultation are performed within one single visit to the hospital. Once heart failure is confirmed, treatment will be started on the day and appropriate follow up arrangements with a heart failure specialist nurse made.

Following this approach, the Princess of Wales Heart Failure team has been able to diagnose, and optimise heart failure treatment within three and a half months compared to the historic 12 months. This has resulted in a four or five fold reduction in the numbers of patients being readmitted to hospital and a similar size reduction in mortality rate. Dr Wong continued, “By targeting patients early on, they have access to life saving therapies much sooner. This gives us the greatest chance of preventing our patients needing more drastic and costly procedures such as having a pacemaker/defibrillator fitted. It also reduces their risk of dying or being readmitted to hospital. Evidence shows that if you have a stay in hospital with heart failure you have 50% chance of returning as an inpatient within a year. We are breaking this cycle and improving outcomes for our patients.”

“We are delighted to see the improved outcome in patients in our service. However, a great deal remains to be done for patients with heart failure. Our local data suggests better outcomes in patients with heart failure can be achieved if they are seen, managed and followed up by a heart failure specialist”.

“There is an urgent need to increase public awareness of heart failure, better access to the NTproBNP blood test and heart scans. We also need to see an increase number of heart failure consultants and specialists nurses across Wales.

“Heart failure is a serious condition but now have the evidence based therapy that can make a massive difference to a patients’ life and outcome.”