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An evaluation of heart failure register reviews and virtual clinics 2016-2018

Session Poster Session 4

Speaker Gayle Campbell

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Multidisciplinary Interventions
  • Session type : Poster Session

Authors : C L Thomson (London,GB), G L Campbell (London,GB)

Authors:
C L Thomson1 , G L Campbell1 , 1Guy's and St Thomas' NHS Foundation Trust - London - United Kingdom of Great Britain & Northern Ireland ,

Citation:

Background

The Integrated Heart Failure Service provides specialist advice and support to local general practices to improve the management of heart failure in primary care.

One way this is delivered is through an annual review of all patients on the general practice heart failure register and a subsequent discussion of the patients as part of a multi-disciplinary team. Virtual clinics are a forum to allow discussion of known heart failure patients, but also those that may be un-diagnosed and need treatment optimisation.

Objectives

To review the virtual clinics undertaken in the last two years, to:

· Ensure all patients on the general practice heart failure register have a confirmed diagnosis of heart failure and are coded correctly as having heart failure with a reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF)

· Ensure all patients on the heart failure register with HFrEF are treated with the maximum tolerated dose or target dose of an ACE inhibitor (or licensed Angiotensin-II receptor blocker) and a beta-blocker, unless contraindicated.

Method

Retrospective review of all heart failure virtual clinics and register reviews conducted between April 2016 and March 2018.  All data were collected and analysed using Excel.

Results

In 2016-17 there were 7 register reviews and 35 virtual clinics, attended by pharmacists, nurses and consultants, and 605 patients were discussed. In 2017-18 this increased to 815 and there were 22 virtual clinics. All 22 practices had completed a register review prior to the virtual clinic.
Results are shown in Table 1 - Outcomes 

Conclusions

There is a clear need for continued support in primary care as a large number of patients are not coded correctly, nor are on optimal therapy for HFrEF. The increase in interventions in 2017-18 shows that completion of a register review ahead of the virtual clinic allows a greater number of patients to be discussed. This in turn leads to more coding amendments, which helps ensure patients are treated correctly, but also has a financial implication for the general practice.

Further work needs to be completed looking at the long-term outcomes of patients following virtual clinic discussion.

Year

2016-17

Year

2017-18

Total number of patients intervened on 409 609
Number of patients with HFrEF 440 401
Number with HFrEF on optimal treatment prior to review 85 156
Number of patients requiring a coding change 218 519
Number of patients with unclear diagnosis requiring confirmation 45 284
Table 1

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