1. Improved Diagnostics and Pathway for Heart Failure Patients An Integrated Approach
Professor Ken McDonald
National Clinical Lead for Heart Failure and
Clinical Director Heartbeat Trust

2. Improved Diagnostics and Pathway for Heart Failure Patients An Integrated Approach
Modern Heart Failure Care
Providing a Solution for all Chronic Illness?
Professor Ken McDonald
National Clinical Lead for Heart Failure
Clinical Director, Heartbeat Trust

3. Two Messages from this Talk
Chronic Disease poses a risk to our healthcare system greater
than anything experienced before
And
2. Solutions are with us but we need to apply them

4. Agenda 2. Goals of Chronic Disease management
3. Managing chronic illness
Using “reactive care” model
1.The Challenge of
Chronic disease
4.The Challenges of
Change
5. Heart Failure;
Providing Solutions

5. The Challenge of Chronic Disease
Chronic Illness in Ireland
38% of those >50yrs have at least 1 Chronic Illness
11% have 2 or more Chronic Illnesses
Account for 80% of GP visits
40% of hospitalisations
75% of hospital bed days
Will grow by 20% by 2020
Driven by age, survival, obesity and DM and…..

6. Goals of Chronic Disease Management
Prevent / Slow the onset of Chronic Illness
Individual responsibility
Population health initiatives
Personalised risk reduction in high risk cohorts
2. When developed, keep the patient well in the community
GP-led care
Ease of access to specialist opinion/ investigations
3. Minimize need for ER referral and hospitalization
Will always be a need but…..
Each hospitalisation directly impacts on outlook
75% of “ER candidates” can be dealt with safely in the community if………..

7. Not Fit for Purpose for Chronic Disease Management
The Acute Care Model:
Not Fit for Purpose for Chronic Disease Management
Primary Care…………………………….Interaction with…………………….Secondary Care
Outpatients ED
Admission

8. The Challenge of Change
The Resistance to Change
Cardiology
Procedure dominated
Reactive
ICS development
Management
“Titanic Syndrome”
AHCP
Pharmacists (community)
Patient
Individual Responsibility

9. Decision time for Chronic Disease
Same Road :
Inevitable collapse of system
New Mode of Care
Healthier
More equitable
Less costly

10. Heart Failure Management:
Clues to the Solution for Chronic Illness

11. What is Heart Failure? A complex chronic illness
characterized by reduction in physical capacity occurring as a result of heart damage
Results in reduced QoL, shortened life expectancy
Significant burden on hospital care with present management structure

12. Heart Failure Numbers Now 2030 Heart Failure Tax in 2030
2% of National Health Care Budgets
>30 billion $ in the USA (Cost of running Ireland for 6 mths)
2030
To escalate by >100% over the next 15 years
70 billion in US
Water Tax in Ireland
160 Euro per year (maybe)
Heart Failure Tax in 2030
250 Euro per year

13. Heart Failure Bed Need: a 600 bed unit occupied all year round

14. Heart Failure Bed Need: a 600 bed unit occupied all year round

15. The Problem as it now Stands

16. Heart Failure Providing Some Solutions

17. eHEALTH Many “medical interactions” don’t require the patient!!!
Keep the limited “real slots” for needed patient review
Outpatients ED
Admission

19. Expedite Specialist Opinion Reduce Patient Referral
Virtual Consultation
Knowledge Dissemination
Reduce Patient Travel

20. Improved Quality of Life
 Morbidity
 Emergency Room Attendance
Hospitalisation
 Effective Use of Diagnostics
Improved Quality of Life
Reduced OPD Waiting Times
Virtual Consultation
Reduce Patient Referral
Reduce Patient Travel
Knowledge Dissemination
Expedite Specialist Opinion
Improve Care
Community Referral
ER Referral
Improved Patient Satisfaction
Decreased Family Inconvenience

21. Improved Quality of Life  Costs
Virtual Consultation
Reduce Patient Referral
Reduce Patient Travel
Knowledge Dissemination
Expedite Specialist Opinion
Improve Care
Community Referral
ER Referral
Improved Patient Satisfaction
Decreased Family Inconvenience
Improved Quality of Life
Reduced OPD Waiting Times
 Morbidity
 Emergency Room Attendance
Hospitalisation
 Effective Use of Diagnostics
 Costs
Positive Public Relation
Chronic Disease in Community
 Public Satisfaction
Improve Quality of Life

22. 85% no further referral saved in travel
200 appointments to date
50,000 km travel saved
85% no further referral saved in travel
Elderly/Frail. Multiple comorbidities. Limited means to travel.

23. A Personalised Prevention Strategy
STOP-HF
A Personalised Prevention Strategy
Common Problem
Home Grown Strategy
Proven
Cost-Effective
Ready to role

24. STOP-HF Hypothesis
NP-driven screening and targeted collaborative care in the general at-risk population will decrease the prevalence of LVD and HF
39 collaborating primary care practices, intervention provided in a single referral center
STOP-HF,
JAMA, 2013

25. Natriuretic Peptides “personalises” Cardiovascular Risk

26. Endpoint – MACE Event Rate
Event Rate OR 0.54 p=0.001 vs. Control
N=71 (10.5%)
N=51 (7.3%)

27. STOP-HF: Cost Effectiveness, n=1054
Ledwidge et al, EJHF (in press)

28. STOP-HF: Cost Effectiveness, n=1054
MACE reduction associated with a shift in costs from secondary to primary care
17,000 MACE hospitalisations in Ireland
Equivalent to 380 bed capacity in system

29. Two Messages from this Talk
Chronic Disease poses a risk to our healthcare system greater
than anything experienced before
And
2. Solutions are with us but we need to apply them

30. A New Approach to Chronic Disease
It is Great Opportunity; Don’t Miss it

31. View from STOP-HF Unit

32. Where / Who should care for HF?
Care should be based in the community and be GP-led
Complex illness needs time-sensitive access to specialist tests/advice at certain critical stages
Not available in Ireland or Western world
Delay to diagnosis
Delay to Rx
Increased Hospital utilization
Compromised outcome

33. Why?

34. Heart Failure Epidemiology

35. Heart Failure Numbers Now 2030 Heart Failure Tax in 2030
2% of National Health Care Budgets
Approx 700million in Ireland
>30 billion $ in the USA (Cost of running Ireland for 6 mths)
2030
To escalate by >100% over the next 15 years
Approximatley 1.5billion in Irelnad
70 billion in US
Water Tax in Ireland
160 Euro per year (maybe)
Heart Failure Tax in 2030
250 Euro per year

36. How Patient Groups Can Make a Difference in Heart Failure
Professor Ken McDonald
National Clinical Lead for HF
Medical Director Heartbeat Trust

37. Expedite Specialist Opinion Reduce Patient Referral
Virtual Consultation
Knowledge Dissemination
Reduce Patient Travel

38. Improved Quality of Life
 Morbidity
 Emergency Room Attendance
Hospitalisation
 Effective Use of Diagnostics
Improved Quality of Life
Reduced OPD Waiting Times
Virtual Consultation
Reduce Patient Referral
Reduce Patient Travel
Knowledge Dissemination
Expedite Specialist Opinion
Improve Care
Community Referral
ER Referral
Improved Patient Satisfaction
Decreased Family Inconvenience

39. Improved Quality of Life  Costs
Virtual Consultation
Reduce Patient Referral
Reduce Patient Travel
Knowledge Dissemination
Expedite Specialist Opinion
Improve Care
Community Referral
ER Referral
Improved Patient Satisfaction
Decreased Family Inconvenience
Improved Quality of Life
Reduced OPD Waiting Times
 Morbidity
 Emergency Room Attendance
Hospitalisation
 Effective Use of Diagnostics
 Costs
Positive Public Relation
Chronic Disease in Community
 Public Satisfaction
Improve Quality of Life

40. The First Personalised Approach to the Prevention of Heart Failure
The STOP-HF Story
The First Personalised Approach to the Prevention of Heart Failure

41. At Risk Population
~1Million
~150 million
Superior Risk Definition and Focused Use of Resources
Critical to CV Management

42. Services in Ireland
Dublin South
Wicklow
Wexford
STOP-HF

43. Services in Ireland
Westmeath
Offaly
Laois
STOP HF Midlands

45. Elderly/Frail. Multiple comorbidities. Limited means to travel.
50,000 km saved in travel
Elderly/Frail. Multiple comorbidities. Limited means to travel.

46. Need Thank you to staff slide Serendipity Need Irish slides
Where we cam from –HFUN in 2004—follow on from serepndipity
NP and tracking risk
More Mayo data
Need to menion that this is off label use of NP
Echo concept and STOP
Risk of Normal Echo and Np

47. View from STOP-HF Unit

48. STOP-HF: Cost Effectiveness, n=1054
Ledwidge et al, EJHF (in press)

49. STOP-HF: Cost Effectiveness, n=1054
MACE reduction associated with a shift in costs from secondary to primary care
17,000 MACE hospitalisations in Ireland
Equivalent to 380 bed capacity in system