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Dr Patricia Campbell Lead Clinician for HF, N. Ireland Heart Failure reduced Ejection Fraction Urgency is requiredJasinska-Piadlo A, Campbell P. Heart 2023;0:1–10. doi:10.1136/heartjnl-2022-321097Projected change in UK by 2040 REAL Centre July 2023: Health in 2040: projected patterns of illness in EnglandHF is on the rise everywhere Source : https://www.health-ni.gov.uk/publications/202324-raw-disease-prevalence-trend-data-northern-irelandPre & Post Pandemic Source : https://www.health-ni.gov.uk/publications/202324-raw-disease-prevalence-trend-data-northern-irelandTime is of the essence Every single encounter with patients counts Heart failure is a progressive condition, but timely optimal medical therapy can prevent deterioration Chronic decline Cardiac function Hospitalisation for acute decompensation episodes Disease progression HF hospitalisations account for 2% of all NHS spending 3. Hartupee J, Mann DL. Nat Rev Cardiol 2017;14:30–38; 4. McMurray JJ et al. N Engl J Med 2014;371:993–1004; 5. Packer M et al. Circulation 2015;131:54–61. Despite evidence to diagnose & treat early, the diagnosis of HF in the hospital setting has grown to ~80% Proportion of HF patients diagnosed in the community or hospital by calendar year 0.8 Hospital Compared with community based diagnosis, n HF diagnosed in the hospital is associated i with a 2-fold increased risk of one year r p 0.6 mortality 1 o p ( l b Half of these people have had a0.4 o symptoms for up to 5 years! r P Community 0.2 18 199 20 201 20 23 20 25 20 20 208 20 20 21 21 21 204 21 206 21 Year of HF diagnosis 1. Lawson CA et al. Lancet Public Health. 2019;4(8):e406-420 14 Figure adapted from Supplement to Lawson CA et al. Lancet Public Health. 2019;4(8):e406-e420 The 5 pillars of HFrEF therapy 2023 nt PrventHF Prve hospialsaio deat nSGLT2i benefits appear very early after initiation DAPA-HF EMPEROR-REDUCED Berg JAMA Cardiol 2021; 6(5): 499-507 Packer Circulation 2021; 143: 326-336Real-life not so greatOur local data – care setting mattersHow about Northern Ireland? • Defining era in health care • Ageing population, largest growth >85y, projected to continue SYSTEMS, NOT STRUCTURES: CHANGING HEALTH & SOCIAL CARE https://www.health-ni.gov.uk/sites/default/files/publications/health/expert-panel-full-report.pdf Accessed October 2019 Background Aims Methods Results Conclusions Acknowledgments Older age, Multi-Morbid Cohort Background Aims Methods Results Conclusions Acknowledgments Patients referred by non-cardiology teams were less likely to be on life-saving therapies Background Aims Methods Results Conclusions Acknowledgments If initial care by non-cardiology team, survival was HALFOur results indicate a need for increased access to specialist Heart Failure care for both primary care & secondary care International Guidelines recommend this (NCEPOD report)Access to specialist HF care can prevent hospitalisationIdeal Streamlined HF Care Screen High Risk T2DM, HTN, CKD Easy Electronic Referral Online form, minimal dataset clear Patient Prioritisation Red Flag (2/6 week) one stop diagnosis & expert HF review 1.Rapid medicine optimization on diagnosis (4 in 4) Dignity Excellent Clinical Care 2. Early post discharge review Throughout throughout the patient journey 3. In-patient HF care 4. Urgent review for symptom emergence (PIFU) Palliative care as needed Heart Failure Rehab For all Comprehensive discharge proforma for patient and primary care Discharge team Easy, rapid access to HF expertise MDT with Primary CareHeart Failure Virtual Clinic SHSCT1. Primary Care Feedback 2. Reduction in wait times to HF specialist opinion 1.Feedback Care 3. % of patients on optimal therapy Pre vs Post HFVCWe can prevent HFSTOP-HF The STOP-HF Randomized Trial. JAMA. 2013;310(1):66–74.llaborative Care for Heart Failure: British Society for Heart Failure 25in25 Initiative Creducing deaths by 25% over 25yearslure:T ake home messages • HFrEF outcomes remain poor • We need to optimize 4 pillar care • No such thing as ‘stable patient’ • Timely care matters HF MDT to primary care improves patient outcomes •1. HF is common, outcomes are poor UNLESS seen early, optimized early 2. CCG Referral pathway roll out soon 3. Join us to transform NI HF care pathways – join the HF Strategic Group (email me to let me know patriciam.campbell@southerntrust.hscni.net) Many thanks