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

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

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

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

NICE algorithm

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!

BNP – the results so far PLEASE BE SUSPICIOUS, & REQUEST MORE! 33 34 June July Aug Sept Oct Total requests 33 34 29 22 27 Positive results (>100) 18 26 35 36 7 % positive Definite under-referral, and probable under-diagnosis PLEASE BE SUSPICIOUS, & REQUEST MORE!

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

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

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.