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Heart failure services from the hospital perspective in the UK: a cross-sectional survey
Chun Shing Kwok1, Susan E Piper2, Christi Deaton3
1Consultant Cardiologist Department of Cardiology, Mid Cheshire Hospitals NHS Foundation Trust, Crewe.
Insights
UK heart failure (HF) services show significant variation. A survey found many services struggle to meet referral targets, indicating potential gaps in patient care across the country.
Area of Science:
- Cardiology
- Healthcare Services Research
Background:
- Heart failure (HF) presents a substantial health challenge in the UK, characterized by disparities in service provision.
- Understanding the current landscape of hospital-based HF services is crucial for identifying areas for improvement.
Purpose of the Study:
- To conduct a cross-sectional survey of hospital-based heart failure services across the UK.
- To assess the structure, resources, and performance of these services.
Main Methods:
- A survey of UK hospital-based HF services was conducted between September 2021 and February 2022.
- Seventy-nine responses were collected, detailing service organization, staffing, diagnostic pathways, and adherence to referral timelines.
Main Results:
- Most clinical leads were cardiologists with an HF specialization (82%).
- Just over half of services offered one-stop diagnostic clinics (median 2/week).
- Referral waiting time targets were rarely met (4% consistently), with 15% never meeting them.
- Services predominantly managed patients with HF with reduced ejection fraction (HFrEF) over HF with preserved ejection fraction (HFpEF).
- Staffing included a median of 2 HF consultant cardiologists and 1-2 HF specialist nurses per service.
Conclusions:
- Significant variation exists in UK hospital-based heart failure services.
- Current service structures and performance, particularly regarding waiting times, may not adequately meet patient needs.
- Further investigation into service optimization and standardization is warranted.
Abstract:
Heart failure (HF) is a significant problem in the UK with variation in services across the country. Here we describe the findings from a cross-sectional survey of HF services in the UK performed between September 2021 and February 2022. Seventy-nine responses describing hospital-based HF services from all devolved countries were received. The clinical lead in 82% of hospitals was a cardiologist with specialist interest in HF. Just over half of HF hospital services had a one-stop diagnostic clinic with a median of two clinics per week. A two-week pathway and six-week pathway were present in 78.5% and 75%, respectively. Only 4% of services met referral waiting time targets 100%, and 15% never met targets. The majority of inpatient HF services reviewed patients with primary (96%) or secondary (89%) admission for HF with reduced ejection fraction (HFrEF), corresponding percentages for HF with preserved ejection fraction (HFpEF) were 68% and 51%, respectively. HF services reported a median of two HF consultant cardiologists, five non-HF consultant cardiologists, one palliative care consultant, two band seven and one band six HF specialist nurses. In conclusion, considerable variation in hospital-based HF services across the UK exist, which may not meet the needs of patients.
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