Heart Failure in the Community Audit

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Heart Failure in the Community - Audit

• Dr Susan Brailsford, PhD, MFPH
• Specialist Trainee in Public Health, Barking
  Dagenham
• Jim McManus, CPsychol, MFPH,
• Public Health Lead

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Acknowledgements

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

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Background

• 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
  intolerance.
• 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
  future.
• 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.

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Aims

• 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
  failure
• 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

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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
  Havering.
• 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.

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Prevalence of Heart Failure
Strongly suggestive of under-reporting
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Mortality

• 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

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Echocardiography

• ECHO was only available in GP surgeries in one
  PCT, however, 6/7 PCTs had HF diagnostic
  clinics.
• 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

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Availability of Specialist Services
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Congruence with HC Review

• Most PCTs need to improve community services
• Most need to improve prevalence
• Pathways not equitable
• Psychological services almost non existent

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Innovations

• 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

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Conclusions

• 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

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Recommendations

• The use of ECHO for confirmation of HF should be
  increased
• 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.

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Next Steps

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

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Psychology and Heart Failure Review Project

• Jim McManus, CPsychol

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Update

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