A programme for delivering a common heart failure treatment in the home or community clinic could reduce the need for many people being admitted to hospital and save the NHS vital funds as shown by the results of our pilot scheme. We are now calling for the initiative to be rolled out by the NHS.
One of the most common symptoms of heart failure, diagnosed in around 550,000 people in the UK but with many more thought to be affected, is fluid retention, arising from the heart’s inability to pump blood around the body effectively, and which can lead to people feeling breathless.
As the condition progresses, oral treatments to combat fluid retention (diuretics) can stop working and many patients have traditionally needed to go into hospital so that they can be treated with intravenous (IV) therapy. The average stay for these patients is approximately 13 days and this treatment alone accounts for two per cent of all NHS bed days. A large percentage of heart failure patients in the UK will need IV diuretic treatment at some point in their illness.
Our two year pilot project looked at 96 patients in 10 NHS organisations around the UK and aimed to investigate if IV diuretics could be delivered safely outside of hospital by specially trained heart failure nurses either in the person’s home or in a community setting close by.
The results showed overwhelmingly that treatment outside hospital was safe and viable and the response was positive with 100 per cent satisfaction from the people receiving the treatment and 93 per cent satisfaction from carers. The project showed that, with specialised training, nurses could safely and effectively provide intravenous diuretics for patients, largely in the comfort of their own homes.
This meant it became unnecessary for many patients to be admitted to hospital to receive a course of treatment, often for many days at a time. This pilot alone enabled 79% of participants to avoid hospital admissions, and saved 1040 in-patient bed days at a saving of £162,740 for the NHS Trusts and health boards involved.
Huge step forward
The project marks a huge step forward towards improving the quality of life for people living with heart failure, as well as their families.
The scheme was set up to help people with advanced heart failure remain at home rather than in hospital and is now being considered and implemented by a number of other NHS organisations, but more needs to be done so that it can become standard practice across the country. People should be able to access this kind of treatment in their own homes, regardless of where they live and provides people with a choice to remain at home at the end of their lives.
Catherine Kelly, our Director of Prevention, Survival and Support said: “IV diuretics is a ground-breaking initiative has the potential to help hundreds of thousands of patients remain close to home rather than spending a cumulative two million bed days in hospital each year.
“This simple but effective change in service delivery shows that true innovation which transforms patients’ lives doesn’t always come in the form of a new drug treatment. This innovation shows how something as simple as changing the location of treatment can improve clinical outcomes improve people’s everyday lives by supporting them to remain at home and avoiding what is often a distressing unplanned hospital admission.”
Heart failure patient Ken Gratton from Bollington, East Cheshire, received his treatment at home: “I turned up to my first hospital appointment in a wheelchair, with my wife pushing me. Because my heart wasn’t pumping properly I had built up a huge amount of fluid in my lungs and my body .I could hardly walk and even after 25 yards I was out of breath. I couldn’t help my wife do any of the normal jobs, and she even had to help me get dressed in the morning.
“Eventually, they put me onto the programme to get intravenous diuretics at home. They took off a lot of fluid from my body and my lungs. They came every day for 60 days. At the start I weighed 139 kilos and when they finished I weighed 89 kilos. The weight I lost was all excess fluid. It has made a tremendous difference. My breathing is better and I can walk as far as I want. The service I received was excellent! I still have damaged heart muscle but I avoided being admitted to hospital and the quality of life for both my wife and I is really different.”
Caroline Senior, who led the scheme at Leeds Community Healthcare NHS Trust, said: “When we started doing this project we took every possible step to ensure that the quality of the treatment we were providing was to the highest standard and comparable with what a patient would receive in hospital. The feedback we got from our patients and their families has been overwhelming and this one simple change in their treatment has had a profound impact on their quality of life. With training and investment from the NHS this has the potential to make a world of difference for heart failure patients across the UK.”
This development will be discussed at the British Cardiovascular Society conference in Manchester. Caroline Senior will be available for interview.
The trusts involved in the IV diuretics pilot
- NHS Greater Glasgow and Clyde
- Aneurin Bevan Health Board
- NHS Ayrshire and Arran
- Dudley Community Services
- South Durham and Darlington Community Health Services
- East Sussex Hospitals Trust
- NHS Leeds Community Healthcare Trust
- Nottingham Citycare Partnership
- Nottingham West Consortium
- Staffordshire and Stroke on Trent Partnership Trust