New ways to manage old problems
There are 920,000 Britons living with a progressive health condition known as Heart Failure, with around 200,000 newly diagnoised each year. The full definition is below, but in a nutshell it means the heart’s pumping action has become less effective. Sadly, most people with the condition have no idea about it, until it suddenly becomes very serious - in the UK 80% of people are diagnosed in A&E.?
There are many things that can be done to live with the condition more comfortably, and slow its progression, when people are aware. Remote monitoring is showing great promise in helping people diagnosed with Heart Failure have greater confidence in managing their condition, have fewer visits to the GP and spend more time in the comfort of their own home.?
For these reasons, NHS England has been running a programme to test this out - known as Managing Heart Failure @Home - with the participating sites collecting and sharing data in the same way, to be able to evaluate the collective impact - an admirable approach.
This is the first in a short blog series on the difference remote monitoring can make to people living with Heart Failure, and indeed to the NHS more broadly, sharing some of the results of this programme that has been running across England, starting with five demonstrators, then extending to a further ten acclerators and more recently extended further, given the excellent results being achieved.
Overview of the programme
The Managing Heart Failure @Home programme or MHF@Home, developed by NHS England, is designed to empower patients with heart failure to better manage their condition from home.?
It focuses on three key areas:
The results are really interesting and one in particular strikes me as particularly important.
Concern is sometimes raised about a move to more care at, or closer to, home adding pressure on GPs. However, this data demonstrates that patients in the tech-enabled cohort are visiting their GP one third less than previously, a really huge reduction.?
A reduction in GP visits of 32%
Similar results have been seen at other mature sites providing remote monitoring for long term conditions - such as Frimley and Airedale. It appears that when easy access is provided to virtual and remote care and in particular nurses with condition specific expertise - we consistently see ED attendances and GP visits reduce markedly.
That’s why I believe tech enabled home care at scale would make such a difference to our NHS - in primary care as well as at the hospital front door.?
The results suggest that this should be the model for many more patients with Heart Failure; it would make a huge difference if everyone with a diagnosis was offered remote monitoring as part of their routine care.?
I’ve been involved as part of the work the East and North Hertfordshire Health and Care Partnership have led - this is a collaboration between health organisations in the area aiming to improve healthcare for the local population and includes Hertfordshire Community NHS Trust and East and North Hertfordshire NHS Trust . The partnership was awarded accelerator funding in the last wave, and the impact has been impressive. These NHS sites and their selected tech partner, Doccla participated in this programme earlier this year, extending the innovative care model for supporting heart failure patients to manage their condition at home through remote monitoring, guided self-management, and patient education.
I’ll talk more about the Hertfordshire work in a dedicated future blog, but in this one I will reflect on some of the context - what Heart Failure is and what the National results tell us.?
What is Heart Failure??
“Heart failure means that the heart is unable to pump blood around the body properly. It usually happens because the heart has become too weak or stiff. […] Heart failure does not mean your heart has stopped working. It means it needs some support to help it work better.
It can occur at any age, but is most common in older people. Heart failure is a long-term condition that tends to get gradually worse over time. It cannot usually be cured, but the symptoms can often be controlled for many years.”
Symptoms of heart failure
The main symptoms of heart failure are:
Some people also experience other symptoms, such as a persistent cough, a fast heart rate and dizziness .
Symptoms can develop quickly (acute heart failure) or gradually over weeks or months (chronic heart failure).
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Impact - interim results after the first 3 months?
The impact of the programme has been really marked. The results provided here are from all the sites involved, this was 10 sites in the first wave and the results were after just 3 months on the programme:?
Improved quality of life - generic
Improved severity of symptoms (KCCQ Scores)?
Improved quality of life - Heart Failure specific (KCCQ scores)?
Greater confidence in self management (KCCQ Scores)
The participants had markedly increased confidence in managing their health condition.?
Reduced GP Visits
GP visits were reduced by one-third in the cohort
Reduced other community visits?
Conclusions?
The findings are impressive, demonstrating a reduction in symptoms, increase in confidence in self management and a key shift away from needing urgent NHS care, via primary or community care, and towards a home based, tech-enabled model. It is interesting to see that other countries are adopting this model at scale such as Denmark and France with remote monitoring for a number of long term conditions.?
There is a great fit with the new government’s missions and the three shifts for the NHS.
I’d love us to get support like this to all people living with severe COPD and/or Heart Failure using simple tech to help them spend more time at home and less unwell and in hospital
- as well as the UK becoming European leaders in Digital Home Care.?
The next stage of the MHF@Home programme involves expanding beyond the ten accelerator sites to further integrate remote monitoring and personalised care into heart failure management across the NHS.
Building on the positive results from the accelerator programme, including improvements in patient quality of life and reduced hospital admissions, the next steps focus on scaling the approach to more regions and refining the integration of care across primary, community, and secondary services.