Heart failure

Background

Heart failure affects 900,000 people in the UK and is particularly prevalent among older people. The condition accounts for about 5% of all medical admissions to hospital, and rates of re-admission are also among the highest for any common condition in the UK. Providing services to patients with heart failure costs the NHS an estimated £625 million each year.

Research indicates that care provided by effective multidisciplinary teams can have a positive impact on outcomes for patients and their quality of life. 

Currently in Lothian, care for patients with severe heart failure care is provided by specialist heart failure nurses in conjunction with GP colleagues. This involves home visits and telephone follow-up.

Early detection of deterioration of symptoms allows timely intervention and may prevent hospitalisation. Deterioration can be detected using relatively simple measures (e.g. history of increasing tiredness, breathlessness, ankle swelling or palpitation) and a measure of the patient's weight, blood pressure and pulse oximetry. Currently these measures are carried out by a visiting nurse on a relatively infrequent basis.

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Telemetrically supported daily self-monitoring of this group may help:

• optimise care
• allow early recognition of exacerbations
• allow intervention to prevent or shorten hospital admissions

Telemetric systems enabling remote patient self-monitoring and relay to clinicians can potentially improve:

• integration between self-management and professional support
• facilitate intensive monitoring and aggressive intervention for those at risk
• provide automated alerts and reminders
• change the way people with long-term conditions self-manage and interact with primary care

NHS Lothian is investing in telemetric self-monitoring equipment for a range of conditions, including congestive heart failure, to develop a new, evidence-based model of care.

The telemetric equipment being deployed provides information to patients and telemonitoring staff, facilitating rapid advice to patients. A patient recording a deteriorating symptom or parameter is immediately detected and contacted by telemonitoring staff allowing timely diagnosis and therapeutic intervention.

Aims

We aimed to see:

• if telemetric services deployed by NHS Lothian are acceptable to patients with congestive heart failure and their clinical staff
• if such services increase or reduce workload for the NHS

Method

We conducted qualitative interviews to learn of patient and staff experiences of using the technology.

Results

Telemonitoring for chronic heart failure: the views of patients and healthcare professionals – a qualitative study (Journal of Clinical Nursing, 2012):