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Introduction Heart failure carries a high morbidity and mortality but increasing numbers of patients are diagnosed with heart failure, with prevalence currently estimated as 26 million worldwide.1 This better recognition of the syndrome is also compounded by the increased number of readmissions for heart failure, which carries an increased mortality risk for heart failure patients.2 We evaluated: the use of NHS digital model for ambulation of heart failure patients called the NHS Test Bed project and the use of digital cardiology to follow up patients to detect early signs of deterioration, and hence prevent readmission. Its importance is recognised increasingly in the global COVID-19 pandemic to help free up inpatient beds. Methods We initially evaluated the time involved in providing an ambulatory heart failure service compared to an inpatient admission for decompensation of heart failure. The NHS Test Bed project is a method of providing access to ambulatory services for heart failure patients and we evaluated the impact of this on admissions, focusing on Emergency Department presentations and emergency inpatient admissions. Results We have demonstrated that an ambulatory heart failure service leads to a reduction in time caring for each patient by 4 hours and 6 minutes compared to an inpatient admission (tables 1 & 2). Our NHS Test Bed study was conducted over a two-year timeframe (inclusive of the introduction of the Combined Application System Innovation (CASI) tool to access ambulatory care services in April 2019) shows a promising linear trend with a step-by-step reduction in Emergency Department presentations for heart failure patients every month (figure 1). However, this was not statistically significant as a greater reduction was seen in the control group who did not have access to this service. The largest study of 1600 heart failure patients used telephone-based heart failure monitoring.3 This showed no reduction in mortality or hospitalisations attributed to this monitoring strategy, but this was attributed to poor adherence with only 55% of patients taking part by the six-month timepoint. The deficit in our study and others in demonstrating a real-world benefit could be attributed to small numbers of patients and short timeframes to evaluate impact. The results also help convey an important safety aspect of using the CASI tool showing a 1.9-fold (95% CI: 1.25 - 2.89;p-value=0.007) increase in the number of emergency admissions for heart failure compared to prior to induction of CASI in the registered users (figure 2). This demonstrates an important triage system embedded in the NHS test bed work in being able to not just send patients to ambulatory care but also filter out patients that need more urgent review. Conclusion It is important to appreciate the importance of an ambulatory heart failure service in freeing up NHS beds. Evaluating the NHS Test Bed project over a longer timeframe with large numbers of patients to reach statistical significance will be of vital importance to prepare for the future surges of the COVID-19 pandemic. |
