An evaluation of service expansion to include patients with heart failure with preserved ejection fraction

Journal article


Peplow, J. and Rees, S. (2024). An evaluation of service expansion to include patients with heart failure with preserved ejection fraction. British Journal of Cardiac Nursing. https://doi.org/10.12968/bjca.2023.0082
AuthorsPeplow, J. and Rees, S.
Abstract

Background/Aims
The Central London Community Healthcare Trust West Hertfordshire heart failure service expanded in 2020 to include patients with heart failure with preserved ejection fraction in addition to the patients with heart failure with reduced ejection fraction. The patient population was predicted to double, requiring staff and
service adjustments; this warranted an evaluation to determine if care targets were maintained. This study aimed to evaluate the impact of service expansion on service
referral rates, length of stay in the service and clinical workload.
Methods
A retrospective quantitative evaluation of the service data from October 2020 to April 2021 was undertaken to compare referral rates, length of stay in service and key
workload metrics between patients with heart failure with reduced ejection fraction and those with heart failure with preserved ejection fraction. All referrals to the service with a new diagnosis of heart failure (confirmed by echocardiogram or magnetic resonance imaging) were considered for evaluation. Of 250 eligible referrals, 81 were selected for inclusion using a random sampling method.
Results
The participants with heart failure with preserved ejection fraction had a median length of stay in the service of 17 weeks. The participants with heart failure with reduced
ejection fraction had a statistically significant longer stay of 35.57 weeks (P<0.001) compared to a pre-expansion length of stay of approximately 17 weeks. Workload was
proportional between the two cohorts. Patients with heart failure with preserved ejection fraction were more likely to be reviewed in multidisciplinary teams or by the consultant
community clinic. This group was less likely to attend clinic, where 96.4% of face-to-face reviews took place at home. Telephone reviews occurred at a similar frequency for both cohorts, comprising 50% of follow ups. The heart failure with reduced ejection fraction cohort required more alterations in medication and medication titration, generating additional follow ups.
Conclusions The service expansion to include patients with heart failure with preserved
ejection fraction has had a significant impact on workload, leading to a reduction in the
quality of care for those with heart failure with reduced ejection fraction.

Year2024
JournalBritish Journal of Cardiac Nursing
PublisherMA Healthcare
ISSN 2052-2207
Digital Object Identifier (DOI)https://doi.org/10.12968/bjca.2023.0082
Publication dates
Print15 Feb 2024
Publication process dates
Accepted16 Dec 2023
Deposited26 Mar 2024
Accepted author manuscript
License
File Access Level
Open
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