An innovative community based Cardiac Diagnostics Service prevents hospital attendances PG. Nolan1, O. Harrington2, J. Barton3, BD. MacNeill1, JJ. Crowley1, PJ. Nash1, K. Daly1 (1) University Hospital Galway, Galway, Ireland (2) Croi Rapid Cardiac Diagnostics, Galway, Ireland (3) Portiuncula Hospital, Galway, Ireland

Background

Echocardiography  Cardiac Ultrasound  Primary tool for diagnosis and follow-up Heart Failure Valvular Heart Disease Structural Heart Disease  Sudden Cardiac Death Paediatric to Geriatric Service  National Clinical Programs Acute Medicine Heart Failure Acute Coronary Syndrome

Background Primary Care Physicians (GP's) have limited access to diagnostics Only 22% have open access As part of the Community Heart Failure Program (ChaMP)  Community based Echocardiography Service commenced (Sept 2008) Croi, the West of Ireland Cardiac Foundation HSE West PCCC Cardiology Departments  University Hospital Galway  Portiuncula Hospital Eur Heart J 2000; 21: 1877–1887

Background  Now extended to include Echocardiography 24hr-7 day Holter monitoring Ambulatory BP monitoring  The only community based Cardiac Diagnostics Service to GP’s in the Republic of Ireland.

Methods Sept Sept cardiac investigations were performed by the service patients underwent echocardiography  accredited Echocardiographer  GE Vivid-i portable echo machine Holter and Ambulatory BP monitor service commenced January patients underwent Holter monitoring 24hours to 7 days 196 had Ambulatory BP monitoring.

Referrals 47.1% of referrals were for reasons commonly seen in acute medicine Dyspnoea Cardiomegaly Palpitations suspected heart failure. All patients had their test performed within 4 weeks of referral with urgent cases receiving highest priority

Results 47.8% of tests were reported as normal Echocardiography results  12.1% of patients had reduced LV function 5.8% mild dysfunction 2.9% moderate dysfunction 3.2% severe dysfunction.  33.3% of patients significant valvular disease 15.4% of cases at least moderate disease

Patient journey Only 8% of tests required rapid direct referral to the Cardiology Outpatient Clinic three cases attended the ED/MAU 92% of cases managed by GP's

Estimated savings In absence of service  OPD referral  MAU/ED referral GUH expects  ED/MAU attendances - 22% estimated direct cost of an ED attendance €162  OPD – 78% estimated direct cost of an OPD attendance €167  Cost of an echocardiogram - €165

Estimated savings Estimated cost of ED attendances  663 x €162  331 x €165  Total € Estimated cost of OPD attendances  2352 x €167  1176 x €165  Total € Total saving

Challenges Lack of perceived value in the normal test Funding Peer-review and audit Increasing referral rate

Conclusion Rapid Access Diagnostics All patients seen in under 4 weeks Prevented an estimated 663 acute admissions Provided estimated savings of €399105