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The NHS Long-Term Plan:

People with heart failure and heart valve disease will be better supported by multi-disciplinary teams as part of primary care networks.

  • 80% of heart failure is currently diagnosed in hospital, despite 40% of patients having symptoms that should have triggered an earlier assessment.

Greater access to echocardiography in primary care will improve the investigation of those with breathlessness, and the early detection of heart failure and valve disease.

Helping at risk CVD patients:

Patients with heart failure, heart valve disease and/or atrial fibrillation commonly present with breathlessness, yet all remain under detected.

It may be difficult to differentiate respiratory from cardiac causes.

  • Up to 20% of patients admitted to hospital with an initial working diagnosis of an acute exacerbation of COPD are shown to have LV failure as the true diagnosis.
  • Nearly eight in ten people are only diagnosed with heart failure after an emergency hospital admission
  • Furthermore illnesses coexist, especially in the elderly.
  • Just under a third of patients with heart failure have valve disease and a patient with current or previous AF is three times more likely to have some form of heart valve disease.

An ageing and growing population means cases are set to rise and in response the NHS Long Term Plan has pledged action to promote earlier diagnosis.

NSHI are committed to reducing health inequality and reducing variability of patient outcomes which remain a challenge in today’s NHS.

NSHI have developed a service in line with the NHS long-term plan, which supports practices in providing a cardiac work-up for breathless patients, where the patients do not have COPD or where the patient’s breathlessness is disproportionate to their lung function i.e., the patient may have an additional co-morbidity.

As people age, they are more likely to have more than one chronic long-term condition.

  • 4.5% of all people aged over 40, lives with diagnosed COPD.
  • 80% of people with COPD have at least one other long-term condition.

The aim of the service is to improve the screening and care pathways, for the following cohorts of patients who present with symptoms of breathlessness whilst undertaking a COPD clinic within your practice:

  • Patient Cohort 1: Patients who may have suspected COPD diagnosis but have non obstructive spirometry.
  • For these patients the NSHI Specialist Nurse Advisor reviews MRC scores and signposts patients with significant breathlessness, i.e. MRC ≥ 3, to be put forward for a full cardiorespiratory examination, FBC, ECG & BNP to ascertain the correct cause of breathlessness.
  • The key to the diagnosis of structural heart disease is the BNP level and echocardiogram.
  • Patient Cohort 2: Patients with confirmed COPD whose breathlessness is found to be disproportionate to their lung function and may have an additional cause of breathlessness.
  • NSHI Specialist Nurse Advisor arranges a 12 lead ECG and venous blood tests which include FBC and BNP.
  • The patient will undertake a full cardio-respiratory examination at their next clinic appointment.

CVD is the leading cause of premature mortality in England, responsible for about a third of all premature deaths. Most of these deaths are avoidable with the best optimised preventive care. Heart failure, stroke and coronary disease make up the bulk of these deaths and these three disease entities are the main focus within the Cardiovascular Optimisation Service Mentoring for Outcome Sustainability (COSMOS) programme, designed and developed by NSHI.

It is well established within the literature, that effective implementation of evidence based care within these disease entities, hugely improves mortality, morbidity and achieves reductions in non-elective admissions. Indeed, the evidence base within CVD is arguably more robust than within any other disease area yet we know that large cohorts of patients within primary care remain sub optimally managed.

Focussing resources on optimising these patients will not only significantly improve patient outcomes but could deliver enormous cost savings  to the NHS, as we know that the bulk of the expenditure within CVD is within in-patient-care following a non-elective admission for a CV event.

This nurse-led programme aims to deliver sustainable, significant and measurable outcomes which will meet the requirements of National Outcomes Frameworks, QOF, QIPP and individual CCG business plans. The programme is designed to utilise current priorities and resources as a starting point in order to develop a staged approach towards a comprehensive CVD service.

The underpinning aim is to provide SUSTAINABLE improvements in cardiovascular outcomes within primary care. In particular, the programme will significantly reduce premature mortality from CVD, hospitalisation rates from CVD as well as improved QOL for patients with existing CVD.