1. Heart Failure: a community-based diagnostic clinic & service
Dr Richard Pile
GPwSI in ECHO/Heart Failure

2. 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

3. 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

4. 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.

5. NICE algorithm

6. 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!

7. BNP – the results so far PLEASE BE SUSPICIOUS, & REQUEST MORE! 33 34
June
July
Aug
Sept
Oct
Total
requests 33 34 29 22 27
Positive results (>100) 18 26 35 36 7
% positive
Definite under-referral, and probable under-diagnosis
PLEASE BE SUSPICIOUS, & REQUEST MORE!

8. 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 ) and advice re management or further referral

9. Administrative bits… First session - 29th November
Fax or referral form
Latter requires ing 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 , as requested, by end of clinic
Follow up arranged by heart failure nurses prn

12. 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.