An advanced type of pacemaker and monitoring equipment are helping to identify when patients with severe heart failure are showing early warning signs of deteriorating health.
The new technology is enabling clinicians at the West Essex Community Cardiac Team at Essex Partnership University NHS Foundation Trust (EPUT) and Royal Papworth Hospital NHS Foundation Trust in Cambridge to intervene early, so that patients can be treated before symptoms get worse.
Patients with severe heart failure are often fitted with an advanced cardiac resynchronisation therapy (CRT) pacemaker, which collects information on their heart health, such as the rhythm and pace of their heartbeat and fluid retention. It also monitors their physical activity.
Patients use their mobile phone or a small monitor which collects data from their pacemaker using technology called CareLink. A specialised assessment tool, TriageHF, then analyses the information and calculates the risk of patients requiring hospital treatment and admission due to heart failure in the next 30 days. Clinicians receive an alert and contact the patient to discuss and review their symptoms. They can then plan any treatment required, with the aim of avoiding the need for patients to be admitted to hospital.
The information is sent to an electronic dashboard for clinicians from both the community team and hospital to view. They will then coordinate contact with high-risk patients within 24 hours to review their treatment and care.
For the community team, this could include reviewing the patient’s medication, treating fluid retention and advising on physical activity. The hospital team provide advice and treatment for heart rhythm and pace as needed.
Royal Papworth Hospital oversees care for about 8,000 people living across the east of England who have remote monitoring cardiac devices. Of these, about 3,000 are monitored via CareLink, of which five live in west Essex. Carelink and TriageHF have been developed by medical device company Medtronic.
Lisa Rose, a Community Heart Failure Specialist Nurse in the EPUT team, said: “Even with our present very small cohort of patients, we are seeing such a positive impact on health and outcomes, which is very exciting.
“It’s really clever technology, which can detect potential problems before symptoms start to show.
“We know that if the assessment tool says a patient is high risk, they have a ten times greater risk of hospitalisation in the next 30 days.
“It allows us to give the appropriate treatment as early as possible and reduce the need for patients to be admitted to hospital.
“Sometimes the data picks up on symptoms which aren’t connected to the heart but allows us to make sure patients get help early.
“For example, if their fluid level is building it could be a chest infection.
“Using our expertise as clinicians alongside the technology enables us to offer more proactive and effective care for our patients, as well as extra reassurance that if there is a problem it will be spotted early.”
Lisa said working more closely with colleagues at Royal Papworth Hospital has improved communication and seamless care. The West Essex Community Cardiac Team has had access to the electronic dashboard since February this year and is the first community team to hold joint clinics with Royal Papworth colleagues.
Ensuring people have access to seamless care closer to home and usingdigital technology to make it easier to get the care they need are two of EPUT’skey priorities.
The Health Innovation Network says around 200,000 people in the UK are diagnosed with heart failure every year. Across the NHS, heart failure accounts for approximately 100,000 hospital admissions and around one million inpatient bed days each year.
Around 40% of people admitted to hospital had symptoms that could have been assessed earlier.
Philip Pelly, 77, was fitted with a CRT pacemaker last year and is one of Lisa’s patients who is trialling the new technology.
Philip, who lives near Braintree, said: “The monitor sits on my bedroom windowsill and downloads information from my pacemaker device.
“The Royal Papworth staff are a wonderful team and I see them every six months and they check it’s all working properly.
“I find Lisa to be absolutely wonderful too, she’s a mine of knowledge. She recommends what medication I need, I know she’s always there if I need to ring her.
“It’s nice to have somebody who has got a bit of time to talk things over with you, it’s a great comfort.”
Sandra Silva, Highly Specialised Cardiac Physiologist at Royal Papworth Hospital, added: “Providing care closer to home is a key priority across the NHS. As the east of England’s regional specialist heart hospital, it’s really important to us that patients don’t travel hundreds of miles to access specialist care that they could get remotely.
“Combining remote monitoring with this co-management technology allows us to identify patients who are at risk of a possible hospital admission for heart failure.
“This model follows NICE (National Institute for Health and Care Excellence) recommendations of caring for patients through structured pathways and integrated services, using digital technology and proactive care, which are all NHS long-term plan ambitions.
“It has been a pleasure to develop our co-management pathway with the West Essex Community Cardiac Team and seeing the benefits of better, safer and faster care for heart failure patients across Essex.”
David Roberts, Senior Regional Business Director for Electrophysiology Therapies, Medtronic UK and Ireland, said: “At Medtronic, we’re proud that our cardiac device technology and the TriageHF risk stratification tool are helping enable more proactive, connected care for people living with heart failure.
“By combining device-derived insights with the expertise of community and hospital teams, clinicians can identify potential signs of deterioration earlier and intervene before a patient’s condition worsens.
“Initiatives like this collaboration between Essex Partnership University NHS Foundation Trust and Royal Papworth Hospital demonstrate how digital health technologies can support more coordinated care, help reduce avoidable hospitalisations, and give patients greater reassurance that they are being monitored and supported closer to home.”
The West Essex Community Cardiac Team provides care for patients living in and around Epping, Loughton, Harlow, Saffron Walden, Hatfield Heath, and Thaxted.
They offer assessment, education and condition management for patients living with heart failure. They also help people back to health following significant cardiac events.
Team members are constantly exploring ways to use new technology and approaches, and working collaboratively with other services, to improve patient care.
About EPUT:
- EPUT is the lead provider across the East of England region for the delivery of the national Op COURAGE Veterans and Reservists Mental Health Service. More information about Op COURAGE can be found on EPUT’s website www.eput.nhs.uk
- EPUT has a vision to be the leading health and wellbeing service in the provision of mental health and community care: Who we are – Essex Partnership University NHS Foundation Trust
- EPUT provides services to more than 100,000 patients at any one time and our staff are focused on providing high quality care in often complex situations.
- The organisation has invested in inpatient facilities and community services to make them safer and more therapeutic. We have extensively invested in technology to keep patients safer, enhanced training, and are continuously working with our staff, patients, their families and carers to use learning and best practice to enhance our quality of care.
- While there is more to do, the Trust has made significant progress through innovation:
- Our 111 mental health crisis phone line ensures people in need can access support 24 hours a day, 365 days a year
- People with lived experience have been employed in designated roles across the Trust, ensuring patient voice is heart of the organisation and all that we do.
- A number of new initiatives have been launched, helping people access the support they need when they need it most. These include a mental health urgent care department, By Your Side maternal mental health service, Rough Sleeper team, mental health crisis ambulance cars, virtual wards and neuromodulation service.
- EPUT was formed on 1 April 2017 and provides community health, mental health and learning disability services across Essex, Luton and Bedfordshire and Suffolk. We employ more than 7,200 staff working across more than 200 sites.
- To read more about our priorities and commitments to deliver the highest quality and safest care possible, visit https://eput.nhs.uk/about-us/2023-2028-strategic-plan/