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

June July Aug Sept Oct

Total

requests33 34 29 22 27

Positive results (>100)

18 26 35 36 7

% positive

18 26 35 36 26

•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.