Some of our achievements:
Developed an early warning and prevention programmes for people with heart failure
Increased public awareness of heart failure and cardiomyopathy
Dramatically reduced A&E visits and unnecessary hospital stays by providing specialist services in the patient’s local community
Created alternative ways of delivering care by using technologies such as mobile phones and broadband to link patients with their GP’s and other services
Carried out new research into Heart Failure causes and care
Build a unique collaboration between hospitals, community care, healthcare professionals and patients for the benefit and ease of the patient care
Hospital Admission and emergency room utilisation has been significantly reduced:
Readmission with acute decompensated heart failure (ADHF) following discharge from hospital has been reduced from 30% at three months to 8%. One year hospital readmission has been reduced from 40% to 15%. International figures for the same metrics are approximately 20-30 for three month readmission and 40% for 1 year. Translated nationally this would save 5,000 admissions which would equate with saving 200 beds every year for alternative use, half the size of a large regional hospital.
Potential new diagnoses of heart failure in the community are seen within 4 weeks of referral expediting correct diagnosis and effective therapy.
To facilitate immediate diagnosis of heart failure when first suspected by the GP, we provide a fast turn-around new diagnostic clinic (NDC) where potential new cases of HF are seen by a hospital consultant and needed immediate tests are done on a same day basis. This bypasses the inevitable delays at routine public outpatients and expedites prescription of effective care and minimises inaccurate diagnoses. To date, in excess of 700 patients have been seen by this service and a follow-up review shows that when identified early, this group has a much improved prognosis.
Seven day ambulatory care provided for patients through GP referral or self referral on weekends and public holidays
To aid our efforts to maintain care in the community and avoid hospitalisation we provide a 7 day ambulatory care service at St Michaels and on-call on weekends and public holidays at SVUH. This service allows patients who are experiencing problems to be reviewed by experienced cardiology personnel on a same day basis thereby minimizing the use of the Emergency Room and hospitalisation.
Increasing delivery of care in the community with development of first advanced nurse practitioner who liaises with General Practitioner in the community to provide care in the patients home
We are the only Unit in the country to develop the Advanced Nurse Practitioner in Heart Failure working in the community. This nurse provides heart failure care in the patient’s home or in nursing homes in concert with the GP and the hospital medical staff, again safely reducing hospital requirement of this population.
We have also expanded this service to work closely with the Community Palliative Care Service for home palliative care of patients with heart failure who are at the end of life stage of care.
Family screening service for those with affected family members
A Family Screening Service has been established to allay concerns of family members of patients who may have a genetic component to their heart failure problem (Dilated cardiomyopathy, Hypertrophic Cardiomyopathy). This service was established earlier this year. Patients are typically screened with ECG and echocardiography and a full physical examination and consultation takes place with Dr Rory O’ Hanlon, our consultant cardiologist with a specialist interest in inherited cardiomyopathy and SCD.
Heart Failure prevention project established since 2005 with regular follow up of more than 1,800 patients at present.
To underline a major focus on Heart Failure Prevention we established in 2005 STOP-HF programme (The St Vincent’s Prevention of Heart Failure Programme) project , to investigate how best to prevent heart failure. This is an internationally recognised project which sets out to review up patients on an annual basis, who by their clinical characteristics are at risk for heart failure. This project requires clinical review, heart scanning and storing of biobank material to be used for ongoing and future research questions related to prevention of heart failure. For more information click here.
Moving Heart Failure Care into the Community
To further optimise HF care and reduce the HF burden in outpatient settings and hospitalisations, we are involved in key research projects studying the potential role of various systems to monitor and treat patients in the community. To this end, we have recruited over 100 patients to various “Telemonitoring” projects. These systems use broadband and blue tooth technology to send patients’ weights and other data to us in the Unit on a daily basis. The data is reviewed by our HF nurse specialists daily and by the cardiology registrar at the weekend, and where clinical concern exists regarding potential patient deterioration, the patient is contacted directly and therapy changes can be made.
Informing National and International heart failure care development plan. There is strong representation from the SVUH group, including the Programme Lead and four other members, on the working group leading the effort defining optimal national heart failure strategies, reflecting the position this Unit holds at a national level.
The St Vincent’s Unit is one of six European centres involved in European Heart Failure Association development of heart failure care strategies