An evaluation of a service expansion to include patients with heart failure with preserved ejection fraction

Abstract

The Central London Community Healthcare Trust West Hertfordshire heart failure service expanded in 2020 to include patients with heart failure with preserved ejection fraction, in addition to the patients with heart failure with reduced ejection fraction. The patient population was predicted to double, requiring staff and service adjustments; this warranted an evaluation to determine if care targets were maintained. This study aimed to evaluate the impact of service expansion on service referral rates, length of stay in the service and clinical workload. A retrospective quantitative evaluation of the service data from October 2020 to April 2021 was undertaken to compare referral rates, length of stay in the service and key workload metrics between patients with heart failure with reduced ejection fraction and those with heart failure with preserved ejection fraction. All referrals to the service with a new diagnosis of heart failure (confirmed by echocardiogram or magnetic resonance imaging) were considered for evaluation. Of 250 eligible referrals, 81 were selected for inclusion using a random sampling method. Data were analysed using Chi square test, Fisher’s exact test or the Wilcoxon signed rank test; a P value of <0.05 indicated statistical significance. The participants with heart failure with preserved ejection fraction had a median length of stay in the service of 17 weeks. The participants with heart failure with reduced ejection fraction had a significantly longer stay of 35.57 weeks (P<0.001) compared to a pre-expansion length of stay of approximately 17 weeks. Workload was proportional between the two cohorts. Patients with heart failure with preserved ejection fraction were more likely to be reviewed in multidisciplinary teams or by the consultant community clinic. This group was less likely to attend clinic, with 96.4% of face-to-face reviews taking place at home. Telephone reviews occurred at a similar frequency for both cohorts, comprising 50% of follow ups. The heart failure with reduced ejection fraction cohort required more alterations in medication and medication titration, generating additional follow ups. The service expansion to include patients with heart failure with preserved ejection fraction has had a significant impact on workload, leading to a reduction in the quality of care for those with heart failure with reduced ejection fraction.