Innovative North Glasgow heart failure service pilot could act as blueprint for entire NHS

An innovative project to help people living with heart failure with preserved ejection fraction (HFpEF) across North Glasgow has been announced by NHS Greater Glasgow and Clyde (NHSGGC) and Boehringer Ingelheim UKIE.

The partnership project aims to address inequity of care by developing a new ‘home-first’ and multidisciplinary team approach for patients who do not currently have access to appropriate support. This could benefit more than 4,000* living with HFpEF across Glasgow¹, who are usually excluded from existing heart failure specialist services across the UK.

* based on the NHS GGC Heart Failure register and an estimate of proportion of up to 50% of those patients having HFpEF - an accurate patient number will be reported as part of the project outputs.

This project will also explore the high economic burden that HFpEF places on the NHS. It will aim to reduce admissions and support early discharge from hospital, as well as provide training for key multi-disciplinary healthcare professionals such as nurses, pharmacists and GPs.

Heart failure with preserved ejection function is a life limiting disease that occurs when the heart is not working as efficiently as it should². This causes symptoms of breathlessness, fatigue and swelling with excess fluid (oedema) which often leads to hospitalisation³.

The partnership⁴ between NHS Greater Glasgow and Clyde and biopharmaceutical company Boehringer Ingelheim is expected to last for 3 years. It will develop, implement and evaluate a comprehensive multidisciplinary heart failure model of care to support patients and their family members who are living with preserved ejection fraction, multiple co-morbidities and complex medical needs within the Glasgow Royal Infirmary and Stobhill Hospital geographical area.

Katriona Brooksbank, R&I Innovation Lead at the West of Scotland Innovation Hub (WoSIH), which is leading on the project for NHSGGC, said:

“This project represents a significant opportunity to ensure that those who require specialist care are able to access the care they need in a community setting. It builds on our previous work at the West of Scotland Innovation Hub in cardiac treatment and addresses a gap in service provision. This is not just the case in NHS Greater Glasgow and Clyde, so this project will hopefully be able to be scaled up and act as a model that could be adopted by other health boards across the country.” 

Dr Karen Hogg, Clinical Lead at NHS Greater Glasgow and Clyde, said:

“The collaboration between NHS Greater Glasgow and Clyde and Boehringer Ingelheim is an exciting opportunity for the heart failure team to identify and characterise the group of patients and their carers who often have very debilitating symptoms of heart failure but preserved left ventricular function on echocardiography. We know that this group of patients have frequent and long hospital admissions, impacting on quality of life, as well as a relatively poor prognosis. Despite this, they do not have the same access to heart failure services that other patients with heart failure do. Characterising their needs, best treatment strategies and developing pathways of care across primary and secondary care will allow us to inform best care for this patient group and potentially impact on the economic burden to the NHS.”

Nick Hartshorne-Evans, CEO and Founder of the UK’s patient led Heart Failure Charity, the Pumping Marvellous Foundation, said:

“Heart Failure with preserved ejection fraction, a type of heart failure, is poorly understood, defined, and badly managed. In many instances, people who have a diagnosis of heart failure don’t know what type of heart failure they have; this is important as the type of heart failure defines the treatments and the care they receive. As a national charity, we can make a good guess as to what type of heart failure the person has by listening to what treatments they have and whether they have access to a specialist heart failure nurse. People with HFpEF tend to have limited treatment and no support from a specialist heart failure nurse, which means inequitable access to NHS guideline-driven treatments and services versus other types of heart failure. This project will inform and generate insights to develop best practices across the UK for this large, disadvantaged, and bypassed group of people, ensuring equity of care for all people living with heart failure.”

Dr Christoph Zehendner, Medical Director at Boehringer Ingelheim UK and Ireland said:

“We have a long history of supporting medical research with the NHS in Glasgow and are excited to now be working together on addressing this high unmet need in heart failure for people living with HFpEF. Ultimately, we all want these patients, and their families, to be able to access the services and support they need across Glasgow, and to see how this can act as a blueprint for NHS services in Scotland, the UK, and other countries.”  

So far, patients have responded positively to the new service, and comments include:

 “Regarding the service given by the nurse Yvonne, I consider it a life saver and without it I would be in dire straits. Her professionalism and attention to detail and the friendly manner in which she dispenses her expertise is beyond reproach and something that I don't think can be surpassed.”

Families are also involved in the project with the carer of one patient saying:

"The heart failure nurse consultant service is invaluable, particularly for my aunt who is housebound. It enables triggers to be identified quickly to enable medication changes which prevent unnecessary/ costly hospital stays and also picks up on anything of wider concern.

“Recently, a blood test run by the service identified low haemoglobin, raising a red flag for my aunt's fatigue and shortness of breath. This allowed the GP to make a referral for iron infusions and a gastroscopy to get to the root cause, all requiring a rebalance of my aunt's heart failure medication.

“I see the service as an absolute necessity and feel so blessed for the difference Yvonne Millerick makes to my aunt's quality of life."

Notes

A recent study published based on English Hospital Episode Statistics (HES) has shown that the cost for a heart failure admission is estimated to be around £3,858 per episode. In the presence of other co-morbidities, such as type 2 diabetes, the study also observed a near 10% increase in the corresponding management cost⁵. In GGC, the number of HF discharge has more than doubled from 2,991 in 2010 to 6,499 in 2020 (ISD SMR01)⁶. Assuming similar hospital expenditure across the two settings, HF admission poses a substantial financial burden to the health system at approximately £25 million per year in GGC. There is a need to optimise the existing, predominantly ‘reactive’ pathway, to better care for patients with pEF outside the acute settings, whilst improving the quality and efficiency of care.  Owing to the shortfalls identified by the primary care rapid diagnostic pathway & the OPERA project, quantifying the overall healthcare burden of patients with HFpEF is incredibly difficult. An inequality in access to care has been identified and the cornerstone of this project is addressing this inequality along with providing unique insight on the health economic burden.

About Great Glasgow and Clyde

NHS Greater Glasgow and Clyde is the largest health board In Scotland, providing healthcare services for a population of around 1.3 million people. NHSGGC hosts the West of Scotland Innovation Hub which supports the co-design and co-development of health and social care innovation across the region, providing end-to-end support, from conception to procurement, in partnership with industry to address key healthcare challenges.

About Boehringer Ingelheim

Boehringer Ingelheim is working on breakthrough therapies that transform lives, today and for generations to come. As a leading research-driven biopharmaceutical company, the company creates value through innovation in areas of high unmet medical need. Founded in 1885 and family-owned ever since, Boehringer Ingelheim takes a long-term, sustainable perspective. More than 53,000 employees serve over 130 markets in the two business units Human Pharma and Animal Health. Learn more at www.boehringer-ingelheim.com/uk/