Introduction The latest NICE guidelines for chronic HF, published in 2018, provided updated recommendations on best practice for the diagnosis and management of HF. How far does current service provision meet guideline recommendations and how do services compare across the UK? We carried out a survey to determine the different models of HF services across the UK, to characterise current service provision and understand how HF is currently managed.
Methods Data were collected from HF services across the UK via postal survey or telephone interview between February and May 2018. Questions included in the survey were refined after 11 pilot interviews with lead HF nurses conducted between December 2017 and January 2018.
Results One hundred HF services completed the survey: 56 HF nurses and 44 HF cardiologists provided data for 67 trusts and 1 social enterprise in England, and 5 health boards in Scotland, 4 in Wales and 2 in Northern Ireland. The average population size served by an HF service was ∼600,000 people (range 22,000 to 3.5 million), with ∼1600 HF patients under their care (range 60–20,000) and ∼480 new HF patients (range 12–2000) referred into the service in the last 12 months. Most services saw patients in both hospital and the community (66%), while fewer saw only hospital (18%) or community (16%) patients. Care in the community was provided by the majority of services for HFrEF (95%) and for end-of-life care, post-MI HF and HFmrEF (∼80% each), while only 53% of services saw patients with HFpEF in the community. The number of HF nurses varied widely between HF services: 1–2 nurses (26%); 3–4 (22%); 5–6 (24%) and ≥7 (28%). Almost one quarter of HF services (24%) had no administrative support, while 15% did not have a consultant with an interest in HF in their area. Only 1 in 4 services (27%) had a pharmacist, while even fewer had a mental health professional (14%) working within their team.
Conclusion HF service provision across the UK is highly variable. Around 1 in 7 services did not have a consultant or a lead physician with an interest in HF, highlighting a deficit between NICE guideline recommendations and clinical practice. The lack of administrative support in a quarter of HF services is of concern considering the large number of patients these services support. Resourcing issues may account for the type of patients HF services see, as considerably fewer services offer care in the community to patients with HFpEF compared with other types of HF.
Funding This study was supported by Novartis. Writing assistance was provided by Hollie Robinson, PhD, of Complete HealthVizion, funded by Novartis.
Conflict of Interest Employee of Novartis
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