Cardiology
also offered Heart Health checks to nearly 5500 people. The Heart Health checks offered were for hypertension, pulse checks for atrial fibrillation and if BEAT symptoms were recognised a point of care test for NT-proBNP.
Managing heart failure in primary care and the community: With nearly a million cases of heart failure at present, and 200,000 cases diagnosed each year, there will be an expectation that primary care will be asked to do a lot more when it comes to managing cases outside of the specialist MDT, in line with one of the Government’s proposed shifts to community interventions. Alongside being better integrated into multi-disciplinary teams, primary care professionals are also starting to realise the dramatic impact they can have on patients through ongoing management, medication optimisation, and patient education. But further change is needed, including
workforce education around heart failure medicines and the importance of cardiac rehabilitation, the rates of uptake for which have not recovered since the pandemic. The patients we consulted for our upcoming report have said that once they are discharged from the MDT, they often feel like they are back to square one - and only likely to receive further medicine optimisation and support if their condition once again worsens. GPs, practice nurses and pharmacists can
proactively identify heart failure patients for medication reviews and potential device interventions, especially those who have been discharged long-term from the MDT. A 2022 study3
found that a primary care heart failure
service, which used retrospective clinical audits to invite patients for a consultant cardiologist review at their GP practice, significantly improved management of legacy heart failure cases. In primary care, 27% of identified heart failure patients were eligible for complex device therapy, while half required optimisation of medication. Optimal titration of the current “big four” heart failure medications - angiotensin- converting enzyme (ACE) inhibitors or angiotensin receptor neprilysin inhibitors (ARNIs), beta-blockers, aldosterone receptor antagonists (MRAs), and sodium-glucose transport protein 2 (SGLT2) inhibitors - is essential for improving survival, reducing hospitalisation, and enhancing quality of life. At St Bartholomew’s, the Heart Failure Rapid
Titration Service has demonstrated the critical importance of this optimisation for patient outcomes. It employs a pathway to expedite patients’ optimisation within 36 days instead
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of the usual six-month period in a virtual ward setting. Patients enrolled in this programme consistently achieved full titration of all four drugs, leading to a one-third reduction in mortality. Similarly, the West of Scotland Innovation Hubs’s early identification through the Heart Failure in the Community project has had success in reducing waiting times for appointments from 12 months to 12 weeks. It invited patients on heart failure diagnosis waiting lists to be reviewed by a rapid multidisciplinary diagnostic service, utilising novel AI analysis of handheld transthoracic echocardiogram images that supported cardiology teams in confirming a diagnosis. Community and PCN pharmacists can also
play an important role in medicine optimisation. Also featured in our upcoming report is an
example of a pharmacist who has had a dramatic impact on local health deprivation through specialising in heart failure. Working within a cardiology MDT they can secure specialist approval to titrate drugs such as sacubitril/valsartan moving patients from severe to mild heart failure. Interest in this specialism is growing. The Alliance recently hosted a webinar for primary care health professionals featuring specialists with 90% of attendees eager to learn more about professional development in the area of heart failure.
The future of heart failure in primary care The growing burden of heart failure represents both a clinical and systemic challenge for the NHS, and one that can no longer be addressed
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