Arrhythmia care coordinators

Atrial fibrillation increases the risk of stroke by up to five times and, in severe cases, some cardiac arrhythmias can result in sudden cardiac death.

These conditions – which include atrial fibrillation (AF), tachycardias and bradycardias – are among the most common reasons for hospital admission, with patients suffering both psychological and physical effects.

AF is the most common sustained adult cardiac arrhythmia in the UK, and costs the NHS more than £2.2 billion each year.¹ Currently, over 1.3 million people have the condition, with an estimated 400,000 thought to be undiagnosed.

With the right care, treatment and support, many people with arrhythmias can get back to living a normal life. However, there has been a missing link between diagnosis and patients feeling supported to really understand their condition.

Innovating for excellence

In 2006, the BHF launched a pilot programme to fund specialist nurses as ACCs. This was in response to a 2005 extension to the National Service Framework for coronary heart disease [PDF] that set out best practice for arrhythmia care.

Our independent evaluation of ACC services in 2010 showed that these posts significantly improved patients’ experiences of services. They prevented more than 4,200 re-admissions a year during the pilot and cut NHS costs.

ACCs provided a single point of contact for patients, coordinating care and performing diagnostic tests, clinical interventions and follow-up outpatient clinics. They also increased awareness and identification of AF through a local audit and the use of validated tools.

What we did

The National Service Framework recommended that patients with long-term conditions should have access to a named ACC to help them manage their illness. Our three-year pilot programme funded 32 ACCs in 19 NHS trusts across England and Wales. The nurses were recruited into primary, secondary and tertiary centres.

Role and responsibilities

Where pre-existing arrhythmia services existed, ACCs redesigned care pathways to improve integration. Where there was no service, ACCs developed one.

ACCs ran nurse-led clinics, ordered patient tests, developed care pathways, made diagnoses and reviewed medication in conjunction with a consultant. They supported and counselled patients, and educated other healthcare professionals about arrhythmic conditions.

Crucially, the nurses also gave out their contact details so that patients could ring with any health worries or problems. Instead of rushing to A&E, patients could turn to their ACC when frightening symptoms returned.

Five vital functions

1. Preventing illness – ACCs diagnosed AF, potentially reducing strokes.

2. Monitoring AF – involves planning the patient care pathway and prescribing medication.

3. Managing cardioversion services – ACCs undertake pre- and post-procedure clinics, patient assessment and titration of anticoagulation therapy prior to performing direct current cardioversion.

4. Providing patient education and support – for instance, they explain to patients with implantable cardioverter defibrillators (ICDs) what physical activity is safe, what to do when the device fires and give practical advice on travel and insurance.

5. Joining up patient care – ACCs are a specialist resource for GPs, healthcare professionals, patients and carers. They help to ensure a co-ordinated approach to integrated, holistic patient care.

What we achieved

Better patient care

• 1,680 patients experienced 844 fewer readmissions in one year as a result of ACC interventions

• ACCs helped to ensure timely access to appropriate services and supported medicines optimisation

• Better patient and carer understanding of the condition and more time spent on patient and carer education

• Significant improvement in patient and carer quality of care

• Enhanced clinical effectiveness, patient and carer experience and cost effectiveness, demonstrated by an independent evaluation

Cost savings

• By making services more efficient and cutting hospital admissions, each ACC makes savings that not only cover their own costs but recoup an additional £29,357 every year.

• Within one year of the pilot, 23.5 ACC roles saved £2.2 million in costs related to reduced hospital readmissions. Taking into account ACC staff costs, this was a net saving of £690,000 across the 19 NHS sites.⁴

£14 million - estimated potential net savings over two years from scaling up the Bristol pilot site model across England

Improved efficiency

• With the redesigned services, GPs referred patients straight to a named ACC for a one-stop-shop of assessments, diagnosis and pre-procedure counselling. Post-procedure follow-up was done at a nurse-led clinic after two weeks, rather than months later by a consultant. This allowed consultants to take on more patients.

• Multidisciplinary clinics brought geneticists, cardiologists and nurses together to provide rapid-access clinics and maximise operational efficiency

• Appointment of ACCs is an effective way of raising awareness of AF across the system, enhancing detection, case finding and optimal management of AF and improving efficiency and productivity at pilot sites. 

Strong patient satisfaction

Thirty patients interviewed gave an overwhelmingly positive response to the ACC service. Many expressed relief at the continuity that came with a designated ACC who co-ordinated their treatment.

What are the benefits of adopting at scale?

• An effective model to more efficiently enhance detection and management of AF and reduce stroke prevalence

• Provides economies of scale across healthcare economies.

Tips for success

After the evaluation, BHF supported ACCs to draw up a business case for the NHS to sustain them, which was successful in 31 out of the 32 original posts.

Our current funding model is to provide a package of financial assistance for professional development, access to BHF courses, events and conferences and resources. 

We now support 56 ACCs across 40 sites, whose salaries and associated costs are paid for by the NHS. 

Resources and information

We submitted data from the ACC evaluation to NICE, where it has joined the Quality, Innovation, Productivity and Prevention collection as a Proven Quality and Productivity Case Study.

For more information about how ACCs could benefit your local population, contact us today.

Contact us

References

1  One year on: Why are patients still having unnecessary AF-related strokes? ABPI, Stroke in Atrial Fibrillation Initiative (SAFI)
2  BHF (2018) Analysis based on Public Health England (2017) Size of the Prize
3  Public Health England (2018) AF: How can we do better guide
4  BHF (2010) Evaluation of the BHF arrhythmia Care Coordinator Awards
5  BHF (2015) Innovation in Practice
6  NICE (2014) AF Guidelines. NICE guidelines CG180 Published date: June 2014 (key recommendations)