Cwm Taf Community Cardiology AF / Palpitation Project Justin Taylor Consultant Cardiologist

Background 2015 - £1m allocated to Heart Disease Implementation Group for community cardiology transforming pathway initiatives Money allocated to each Health Board on a proportional population basis (£95k for Cwm Taf) Each Health Board developed own initiatives based on current service provision and local population needs

Cardiac Network funded GPwSI training Cwm Taf 3 GPs Cwm Taf Successful Health Technology fund application for £149k GP backfill funded from Primary Care

Cwm Taf model proposal Low risk AF and palpitations Short waiting time One stop clinic with little requirement for F/U Investigations done on same day

Anticipated benefits Reduced referrals to secondary care Improvement in RTT Reduction in patient anxiety Reduced acute admissions hospital

Process flowchart GP consultation in GP Practice Referral to community clinic using WCCG Triaging of GP referrals in Secondary Care Patient phoned + appointment letter AF clinic ECG + Echo Palpitation clinic ECG (+ Echo) Ambulatory monitoring + Investigations arranged Follow-up in Secondary care Discharged Follow-up in Community clinic

Cwm Taf model Fortnightly clinics in Keir Hardie Health Park 2 GPwSI + Arrhythmia nurse Echo physiologist ECG/monitor physiologist Cardiology consultant Started End of November 2016

Monthly referral rate

Monthly Activity rate

Referral vs Activity

Clinic Outcomes Number of appointments 197 Number of attendances 176 DNA rate 11% ECG 176(100%) ECHO 109 (62%) Ambulatory monitor 136 (77%)

Clinic Outcomes Number of attendances 176 Number of discharges after Ix 176 Long term rhythm management 4 Long term valve monitoring ~10 UHW arrhythmia 2 Cardiac CT 3 Angiogram 2 DSE 3

Clinic Outcomes Other diagnoses Readmission to A&E afterwards 3 Mod/severe heart failure 2 SVT 4 Dilated Aortic root 2 Readmission to A&E afterwards 3 Re-referral to secondary care 0 Death 2

Summary 176 low risk AF/Palpitation patients seen Rapid appointment - waiting time 4 weeks Rapid Ix - most Ix done on the day Low rate of secondary care follow-up – approx 9% Very few admissions to A&E with same problem – approx 2% Effectively saved 19 consultant DCC sessions worth of OPD activity in 8 months (nearly 3 weeks)

The future Patient satisfaction questionnaire Full cost analysis Vision 360 Expand population group covered

The Team Annie Hughes, Laura Lewis Imran Gilani Dave Tyler/Catherine Templeton Susan Nolan/Lalit Bhalla/Gobi Navaratnum Bikram Chowdhary/Shyama Velupillai/Gafyn Rees Paula Yeo