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Heart Failure in the Community Audit


Heart Failure (HF) is a debilitating illness characterised ... Hamlets; Newham; City and Hackney; Waltham Forest; Redbridge; Barking and Dagenham and Havering. ... – PowerPoint PPT presentation

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Title: Heart Failure in the Community Audit

Heart Failure in the Community - Audit
  • Dr Susan Brailsford, PhD, MFPH
  • Specialist Trainee in Public Health, Barking
  • Jim McManus, CPsychol, MFPH,
  • Public Health Lead

  • NEL Cardiac Network
  • Dr Su Brailsford
  • Prof Ian Rivers
  • The British Psychological Society
  • The Healthcare Commission

  • Heart Failure (HF) is a debilitating illness
    characterised by episodes of remission and
    relapse. At its most severe patients experience
    dyspnoea, oedema, fatigue, lethargy and exercise
  • It is estimated that 2 of people over the age
    of 45 have HF in the UK.
  • During 2006 The Healthcare Commission requested
    trusts to submit information on HF services
    including end of life care. Locally the North
    East London Cardiac network used this as the
    basis for a local needs assessment to look at at
    local needs and provision and plan for the
  • North East London has one of the highest rates of
    coronary heart disease. This area covers both
    deprived inner city PCTS and also extends out to
    the suburbs and the Essex border.

  • To assess the prevalence of HF in NE London
  • To assess services available to people with HF
  • To assess the number of people dying with heart
  • To assess palliative care services available for
    people with HF
  • To develop a care pathway for Heart Failure with
    primary, secondary and palliative care colleagues

Methods and Objectives
  • Methods was carried out across the 7 PCTS within
    The North East London Cardiac Network- Tower
    Hamlets Newham City and Hackney Waltham
    Forest Redbridge Barking and Dagenham and
  • Objectives
  • Assess prevalence of heart failure from heart
    failure registers using QMAS and QOF data
  • Assess services available by trawling The
    Healthcare Commission submissions
  • Use mortality files to assess number of people
    dying from heart failure (ICD-10 code 50)
  • To use this needs assessment as a basis to
    develop a care pathway with stakeholders for HF
    patients in the last year of life.

Prevalence of Heart Failure
Strongly suggestive of under-reporting
  • Three year mean for 3 inner 1 outer London PCTs
  • CHD mortality 9-20 of all deaths
  • HF 1.8-2.4 of all deaths
  • Strongly suggestive of under-reporting

  • ECHO was only available in GP surgeries in one
    PCT, however, 6/7 PCTs had HF diagnostic
  • 6/7 PCTs reported a wait for ECHO of lt13 weeks,
  • Recall guidelines
  • Stable patients 5/7 PCTs recalled every 6 months
  • Unstable patients one PCT recalled every 2 weeks

Availability of Specialist Services
Congruence with HC Review
  • Most PCTs need to improve community services
  • Most need to improve prevalence
  • Pathways not equitable
  • Psychological services almost non existent

  • Building community-based integrated CHD team
  • Integrated team across primary, secondary and
    tertiary care with Local Enhanced Service for HF
  • One-stop shop for ECHO, diagnosis and treatment
  • Working with Macmillan nurses
  • Open access ECHO. Development of CD-ROM for use
    during consultation

  • The prevalence of HF and mortality due to HF
    lower than expected
  • Unstable patients were unlikely to be recalled
    regularly for review.
  • A range of innovative services were available,
    but not uniformly for everyone. Variable access.
  • End of life care provision varied across the
    sector, there was a lack a specific pathway for
    the last year of life in many PCTs

  • The use of ECHO for confirmation of HF should be
  • The innovative methods across primary, secondary
    and tertiary should be shared across the sector.
  • Guidelines for recall should be put in place for
    unstable patients. These patients are more likely
    to be closer to death and require input from
    medical and social care teams.
  • End of life care need may need input from a
    generic longer term conditions team who can
    manage pain, breathlessness and psychological and
    spiritual needs of dying patients with specialist
    disease-specific input as required from HF nurses
    and GPwSIs.

Next Steps
  • Report circulated
  • A conference is planned to feed-back results and
    take forward development of care pathway
  • Psychological Morbidity needs assessment report
  • Expert Seminar on psychological services
  • Recommendations to commissioners

Psychology and Heart Failure Review Project
  • Jim McManus, CPsychol

  • This project is now underway and will be
    reviewing evidence for psychological support and
    heart failure
  • A national expert seminar is currently being
  • A report on how people with HF can benefit from
    psychological services will be produced
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