1. Cwm Taf Community Cardiology AF / Palpitation Project
Justin Taylor
Consultant Cardiologist

2. Background
£1m allocated to Heart Disease Implementation Group for community cardiology transforming pathway initiatives
Money allocated to each Health Board on a proportional population basis (£95k for Cwm Taf)
Each Health Board developed own initiatives based on current service provision and local population needs

3. Cardiac Network funded GPwSI training
Cwm Taf 3 GPs
Cwm Taf Successful Health Technology fund application for £149k
GP backfill funded from Primary Care

4. Cwm Taf model proposal Low risk AF and palpitations Short waiting time
One stop clinic with little requirement for F/U
Investigations done on same day

5. Anticipated benefits Reduced referrals to secondary care
Improvement in RTT
Reduction in patient anxiety
Reduced acute admissions hospital

6. Process flowchart GP consultation in GP Practice
Referral to community clinic using WCCG
Triaging of GP referrals in Secondary Care
Patient phoned + appointment letter
AF clinic
ECG + Echo
Palpitation clinic
ECG (+ Echo)
Ambulatory monitoring + Investigations arranged
Follow-up in Secondary care
Discharged
Follow-up in Community clinic

7. Cwm Taf model Fortnightly clinics in Keir Hardie Health Park
2 GPwSI + Arrhythmia nurse
Echo physiologist
ECG/monitor physiologist
Cardiology consultant
Started End of November 2016

8. Monthly referral rate

9. Monthly Activity rate

10. Referral vs Activity

11. Clinic Outcomes Number of appointments 197 Number of attendances 176
DNA rate 11%
ECG (100%)
ECHO (62%)
Ambulatory monitor 136 (77%)

12. Clinic Outcomes Number of attendances 176
Number of discharges after Ix 176
Long term rhythm management 4
Long term valve monitoring ~10
UHW arrhythmia 2
Cardiac CT 3
Angiogram 2
DSE

13. Clinic Outcomes Other diagnoses Readmission to A&E afterwards 3
Mod/severe heart failure 2
SVT
Dilated Aortic root 2
Readmission to A&E afterwards 3
Re-referral to secondary care 0
Death

14. Summary 176 low risk AF/Palpitation patients seen
Rapid appointment - waiting time 4 weeks
Rapid Ix - most Ix done on the day
Low rate of secondary care follow-up – approx 9%
Very few admissions to A&E with same problem – approx 2%
Effectively saved 19 consultant DCC sessions worth of OPD activity in 8 months (nearly 3 weeks)

15. The future Patient satisfaction questionnaire Full cost analysis
Vision 360
Expand population group covered

16. The Team Annie Hughes, Laura Lewis Imran Gilani
Dave Tyler/Catherine Templeton
Susan Nolan/Lalit Bhalla/Gobi Navaratnum
Bikram Chowdhary/Shyama Velupillai/Gafyn Rees
Paula Yeo