Transforming heart failure diagnosis pathway to improve the patient journey

Diagnosing heart failure is complex and often delayed by operational or system issues.

Up to 80% of heart failure diagnoses are made during emergency hospital admission.

Situation

Glasgow has 1 of the highest rates of coronary heart disease in the world and 5,000 patients waiting for echocardiography.

NHS Great Glasgow and Clyde (NHSGGC) wanted to transform the patient diagnosis pathway for heart failure. It wanted to:

• take advantage of recent advances in electrocardiogram and echocardiogram (echo) technology
• evaluate new artificial intelligence technology
• reduce waiting lists

Aspiration

NHSGGC wanted to develop a digital service that transforms the end-to-end heart failure pathway.

They wanted a solution that would integrate data from separate systems, reducing manual work and time between touchpoints. It would use suitable diagnostic services to help clear backlogs and prevent them from getting out of control again.

Solution

The Lenus Health Heart Failure Service shows data on 1 dashboard from:

• GP referrals
• electronic patient records (EPR)
• diagnostics

This allows clinicians to diagnose and create comprehensive clinical management plans quickly.

It’s a one-stop service for heart failure diagnostic tests and nurse-led, focused consultation and examination.

The service:

• supports a seamless patient and clinician experience across the entire heart failure diagnosis pathway
• allows data entry from clinical examinations
• enables caseload management
• automatically sends case outcome information back to the EPR and primary care systems

Patients diagnosed with heart failure then move on to a virtual asynchronous management service. They are closely monitored using data collected from daily diaries and wearables during therapy stabilisation.

Medication is optimised based on changes in the patient’s:

• blood pressure
• heart rate
• weight
• symptoms

Virtually managing heart failure patients helps to reduce admissions by detecting clinical deterioration earlier.

Impact

NHSGGC receives between 1,500 to 2,000 referrals to their heart failure diagnostics service every year.

Since introducing the digital service in 2021, NHSGGC has seen many efficiencies.

Heart failure diagnosis waiting times reduced from 12 months to 6 weeks across the Health Board, which has a population of 1.2 million.

Consultants delivered 10 clinical management plans in the same amount of time required for 4 face-to-face new patient consultations.

The number of referrals for people who needed a heart failure diagnostic test reduced by more than 30%. This was due to digitally supported Active Clinical Referral Triage and remote patient management.

The number of echo tests also reduced. Each test takes 45 mins and requires highly trained healthcare staff.

As a result of using the digital diagnostic service, the number of new patient appointments also reduced. Only 20% of patients needed a follow-up appointment with a cardiology consultant.

Functionality

The solution is delivered via a cloud-based clinical dashboard that integrates with EPR and labs systems.

Patients have access to a web application that enables them to contribute health data in before their appointment. This helps to reduce the time required for data collection on the day.

Patients diagnosed with heart failure move on to a virtual management service during therapy stabilisation. They have ongoing virtual reviews in line with clinical best practice.

Capabilities

The service supports:

• appointment management
• case workflow
• data integrations

Scope

The service is currently used in secondary care settings.

By using digital services to deliver the pathway, this means some parts can be moved into community settings. This is currently being explored.

Key learning points

• Ensure that the service interfaces are designed with clinicians and patients.
• Use Fast Healthcare Interoperability Resources (also known as FHIR) standard for integrating health data.

Key quotes

“Digitisation of the heart failure diagnostics service in NHSGGC has revolutionised the way we work and has enabled NHSGGC to provide equitable and more timely access to heart failure diagnostics and heart failure care.

This is crucially important because we know that early diagnosis and therefore early initiation of heart failure treatment reduces the risk of hospitalisation and death for these people, within only 4 weeks of starting therapy.”

Dr Clare L Murphy, Consultant Cardiologist, NHS Greater Glasgow and Clyde

Find out more

Heart Failure Service on Lenus Health website

Key contact

Dr Clare L Murphy, Consultant Cardiologist, NHS Greater Glasgow and Clyde

clare.murphy@ggc.scot.nhs.uk

Paul McGinness, Director, Storm ID and Lenus Health

paul.mcginness@lenushealth.com