Transcript Heart Failure & BNP

Heart Failure:
a community-based diagnostic
clinic & service
Dr Richard Pile
GPwSI in ECHO/Heart Failure
Heart Failure – the facts
• Syndrome resulting from any structural
or functional cardiac disorder that
impairs the ability of the heart to
function as a pump
• 900, 000 people in the UK
• 1 in 35 people aged 65-74
• 1 in 7 aged over the aged of 85
• Commonest cause in UK is CHD
• 40% die within the first year of diagnosis
Heart Failure.. more facts!
• average GP looks after 30 patients with
heart failure
• Diagnosis suspected in >10 new patients
per year
• Costs the NHS £716 million per year
• 2% of NHS inpatient bed days, and 5 % of
acute medical admissions
• This is going to increase in future
Management of Heart Failure
• NICE guidance published 2003
• for adult patients with chronic heart
failure
• aims to symptoms/signs/Ix to establish
Dx
• also gives guidance on the treatment,
monitoring and support of patients with
heart failure.
• http://www.nice.org.uk/pdf/CG5NICEguide
line.pdf
NICE algorithm
Brain Natriuretic Peptide
• BNP is a good test for ruling out heart
failure (negative predictive value = 98%)
• Testing launched for St Albans and
Harpenden practices in June 2004
• Put “BNPS” on form, sample send purpletopped tube, on same day it is taken
• Limited uptake so far…spread the word!
BNP – the results so far
June
July
Aug
Sept
Oct
Total
requests
33
34
29
22
27
Positive
results
(>100)
18
26
35
36
7
%
positive
18
26
35
36
26
•Definite under-referral, and probable under-diagnosis
•PLEASE BE SUSPICIOUS, & REQUEST
MORE!
Heart Failure diagnostic clinic
• GP/PHCT referral as per NICE guidance (see
referral form) for newly suspected heart failure
• 2 sessions per week, 4 patients per session
• Based in SACH Day Hospital
• Run by GPwSI and specialist Heart failure nurses
• Echocardiography to assess LV systolic function
• Counselling re diagnosis and follow up for as
appropriate
• Immediate feedback (fax or email) and advice re
management or further referral
Administrative bits…
• First session - 29th November
• Fax or email referral form
– Latter requires emailing from an NHS net address, to
the specified NHS net address.
• Minimum of important details required
• Appointment arranged by clinic clerk and patient
contacted
• Feedback by fax or email, as requested, by end of
clinic
• Follow up arranged by heart failure nurses prn
Heart failure care pathway Summary
• Heart failure is a common, complex and serious
syndrome.
• It is difficult to diagnose clinically, and to manage.
• We can improve the diagnosis, investigation,
management, and outcome for our patients.
• There is now a local service to facilitate this, in a
primary care/community setting – supporting the
patient’s own practice, if required, in managing
their heart failure optimally.