Specialists provide comprehensive care for heart failure patients
A new service has bolstered care for patients with heart failure at Canterbury Hospital.
Heart failure is an extremely common clinical condition and cause of presentation to hospital. The rate of heart failure presentations is growing in conjunction with our ageing population. These patients are at high risk of early re-admission to hospital if not adequately managed while they’re in hospital and then in the community following discharge.
“We also know that heart failure patients who require early and frequent re-admission have a worse overall prognosis,” Staff Specialist Cardiologist Dr Rominder Grover said.
The Rapid Access Heart Failure Clinic aims to improve a patient’s quality of life and reduce the risk of them having to return to hospital for treatment.
The Australian Heart Foundation describes heart failure as a condition where the heart no longer pumps blood around the body as well as it should. It can be caused by a range of conditions including coronary heart disease and heart attack, high blood pressure, faulty heart values, inflammation or damage to the heart’s muscle and an abnormal heart rhythm.
Two years ago, an audit was conducted at Canterbury Hospital during which the cases of 40 patients, admitted to the hospital with heart failure, were reviewed.
The case review examined a patient’s initial assessment and diagnosis, the treatment they received during their hospital stay, and their access support services once they’d been discharged.
It found that 11 of the 40 patients (28 per cent) were re-admitted to hospital within 30 days. It prompted the hospital to embrace a comprehensive multidisciplinary approach to the care of patients with heart failure.
Data now shows the approach, including setting up the Clinic, is having a positive impact.
While the number of patients admitted to hospital with heart failure rose (from 443 in 2017-2018 to 471 in 2018-2019), the re-admission rates dropped by 3 per cent to 13 percent.
A standard assessment procedure has been developed for doctors and nurses to guide the care of heart failure patients admitted to hospital including the establishment of a regular echocardiogram service on site which has streamlined patient access to the service.
“An echocardiogram – or ultrasound of the heart – helps clinicians to diagnose the possible cause of a patient’s heart failure. So far this year, I’ve done up to 600 of them for inpatients at the hospital,” cardiac sonographer Catherine Spadola said.
The ultrasound is a powerful diagnostic tool.
“It allows us to assess the structure of the heart. We can visualise the four chambers of the heart and the valves. It’s critical to identifying what might be the cause of a patient’s condition and then we can work out how to best care for them,” said Dr Grover.
When a patient is discharged from Canterbury, they’re provided with information and resources about heart failure and linked to further community-based support services.
And, they’re referred to the Rapid Access Heart Failure Clinic staffed by Dr Grover, fellow cardiologist Dr Javed Sheriff, and Clinical Nurse Specialists Antoniette Arrastia and Simone Gray.
The Clinic, which began operating in July last year, provides follow-up for patients within a week of their discharge from hospital. It’s designed to ensure they are reviewed early – given a patient’s re-admission to hospital most often occurs within four weeks of discharge.
The Clinic is run on Tuesdays and Thursdays in the hospital’s Outpatients Department.
“Every patient who is admitted to the hospital has to be seen by one of us within seven days of being discharged. We want to make sure they’re on the right medical pathway and that they’re taking the correct medication,” Dr Sheriff said.
Patients are also reviewed by one of the nurses who educates them about how to better manage their condition to prevent further acute episodes. It involves ensuring patients monitor their weight, fluid intake, and diet and devising and implementing a heart failure action plan.
“We’re monitoring each patient’s progress. We do a physical check-up. We make sure that they’re taking their medication. And, we chat to them about how to manage their condition now that they’re at home,” Ms Arrastia said.
They also carry out home visits.
“It’s important that patients become aware of the early signs and symptoms of their condition. These can include increases in weight, swelling of the legs or shortness of breath. These are all indicators which may mean that they need medical attention,” Ms Gray said.
The patient feedback has been positive as the service continues to grow.
“We’re providing first-class care throughout the patient’s journey from their admission to hospital, their treatment, and their follow-up care once in the community. Our aim is to improve each patient’s quality of life and to reduce their risk of re-admission to hospital,” Dr Sheriff said.