Evaluating the costs and resources of implementing a new heart failure care pathway called ‘TriageHF Plus’
What is the Triage Heart Failure Plus care pathway?
The Triage Heart Failure Plus (TriageHF Plus) care pathway combines remotely monitored health data, routinely collected by a patient’s cardiac implanted device with a clinical care pathway. The data consists of heart health parameters which are routinely collected at home by their cardiac implanted device on a daily basis. Based on the data, the patient is stratified as being at low, medium or high risk of hospitalisation due to worsening heart failure in the next 30 days, according to the Medtronic Triage Heart Failure Risk Score (HFRS). When a patient transitions into high risk, an alert is transmitted to the heart failure team which triggers a telephone assessment and any acute issues are identified and managed in line with guideline recommendations, most commonly medication changes. The patient is then followed up over the next 30 days to monitor changes and manage their risk.
This work follows on from pevious work on Smart Hearts; which involved the use of data to improve care for people with heart failure.
What are we trying to do?
In partnership with data scientists based from our Digital Health team, colleagues form the University of Manchester and Medtronic, Manchester University NHS Foundation Trust are leading a prospective real-world evaluation study with the aim of understanding the clinical workload burden associated with implementing the Triage Heart Failure Plus care pathway.
Why is this important?
Knowledge of a patient’s deterioration early with respect to heart failure parameters can alert the clinical team to allow for proactive measures to be implemented at an earlier time point, as opposed to traditional models of care which often identify patients at a much later stage, by which time admission to hospital is often unavoidable.
The TriageHF Plus care pathway, developed by Manchester-based Consultant Cardiologist Fozia Ahmed, provides the potential to reconfigure care pathways to prevent avoidable hospital admissions. If confirmed to be transferable (including cost-effective), this may shape the future delivery of heart failure care, allowing increased focus and to be placed on those patients with a High Triage Heart Failure risk status.
How are we doing it?
Patients have been recruited from three hospitals across Greater Manchester; Manchester Royal Infirmary and Wythenshawe Hospital (both part of Manchester University NHS Foundation Trust), as well as The Pennine Acute Hospitals NHS Trust (part of the Northern Care Alliance NHS Group). A heart failure nurse at each site reviewed the transmission logs on a biweekly basis and performed telephone consultations in response to a high alert. The time spent reviewing transmission logs and performing telephone consultations was recorded throughout the study to enable an understanding of workload burden associated with the pathway.
In addition, data scientists will be analysing hospitalisation data to understand if the implementation of the pathway had an effect on unplanned cardiovascular related hospitalisations within these patients.
This piece of research will look to:
- Estimate the heart-failure related clinical workload associated with implementing the Triage-Heart Failure Plus care pathway.
- Compare frequency and type of clinical touchpoints and patient outcomes pre-Triage-HF Plus (current state) and post-Triage-Heart Failure Plus Implementation (future state, prospective).
- Estimate cost of Triage-Heart Failure Plus care pathway at each site
- Clinician perception of the Triage-Heart Failure Plus care pathway (qualitative)
- Explore relationships between Triage-Heart Failure with patient demographics and heart failure events, along with non-heart failue events (such as fraility)
Who are we working with?
Ahmed FZ, Sammut-Powell C, Kwok SC, Tay T, Motwani M, Martin GP, Taylor JK., (2021). Remote monitoring data from cardiac implantable electronic devices predicts all-cause mortality. EP Europace, euab160
For further information please contact Sue Wood