Heart Failure - Patient Pathways
"The patient seeing the right person at the right time.” To patients, politicians and commissioners this seems a glaringly obvious thing to happen. However to health professionals, trying to help the patient navigate a very complex organisation like the NHS is not as easy as it sounds. Uncertainty around diagnosis, the need for “choice” , and the barriers of purchasing and providing often hinder rather than help that process. This is where the patient pathway described here aims to offer clarity.
Heart failure is a complex clinical syndrome causing patients to experience breathlessness, fatigue and fluid retention due to functional or structural cardiac abnormalities. The National Service Framework for Coronary Heart Disease described heart failure as the final common pathway for the many cardiac conditions that affect heart pump function, with coronary artery disease and high blood pressure as the most common antecedent conditions. Although the increasingly successful management of these diseases, particularly intervention for heart attacks, has improved survival, the trade off lies in a burgeoning clinical cohort living with left ventricular dysfunction. Heart failure is now the only cardiovascular disease increasing in prevalence.
In the United Kingdom, heart failure affects about 900,000 people with 60,000 new cases annually, and is predominantly a disease of older people with all their attendant comorbidities. At least 5% of those aged over 75 years are affected, rising to about 15% in the very old. Given the relative aging of the general population, those with heart failure will continue to consume a major and increasing proportion of clinical and public health resources. Heart failure is a high cost Healthcare Resource Group (HRG) and multiple hospital admissions, a common feature of advanced heart failure, account for a significant amount of this health care expenditure. For the year 2009- 2010, there were almost 113,000 admissions with heart failure in England and Wales, requiring more that 754,000 bed days. Some of these admissions might be avoided with anticipatory care planning and the provision of community health and social care support
Pathways for heart failure care
Making improvements in heart failure services: Final reports from the national pilot sites (2008/10)
Introduction to the audio clips - Mike Connolly, NHS Improvement National Clinical Lead
Introduction to the management of supportive and palliative care in heart failure - Dr James Beattie, NHS Improvement National Clinical Lead