The implementation of a Cardiac Scientist Led Heart Failure diagnosis clinic for non-urgent suspected heart failure referrals

Abstract

Background: NICE guidelines suggest that patients with suspected heart failure (HF) and an NT-proBNP between 400-2,000ng/l have specialist assessment and transthoracic echocardiography within 6 weeks. Typically, pathways require significant coordination of a multidisciplinary team, with upfront input from senior clinicians. In line with NHS workforce plans to develop non-medical roles, a Cardiac scientist led Heart Failure assessment clinic for non-urgent suspected HF referrals was trialled. A British Society of Echocardiography accredited physiologist with health assessment and clinical examination qualifications performed a transthoracic echocardiogram, 12 lead electrocardiogram and clinical assessment within one appointment slot. Preliminary outcome recommendations made by the physiologist were reviewed at a later point by a supervising HF consultant. The pilot aimed to ensure timely clinical assessment at the point of echocardiography and reduce delays in patient diagnosis. In a retrospective service evaluation, the clinic decision and time from scan to outcome correspondence was compared between the cardiac clinical scientist led pathway (n = 100) and the medical led pathway (n = 100). Results: Both patient groups were found to have similar outcomes. In the clinical scientist led pathway 65% were discharged, 6% were found to have HF with reduced ejection fraction (HFrEF), 20% were found to have HF with preserved ejection fraction (HFpEF), 7% were referred into general cardiology, 1% were referred to the cardio-thoracic surgical team and 1% were admitted. In the medical led pathway, 61%, were discharged, 7% were found to have HFrEF, 23% were found to have HFpEF, 6% were referred into a general cardiology, 3% were referred to the cardio-thoracic surgical team and 0% were admitted. A significant reduction (30.1 days vs. 10.6 days) in time was observed from echocardiogram to outcome correspondence for patient. (p < 0.01). Conclusion: The scientist led pathway demonstrated improved time from diagnostic testing to outcome correspondence, ensuring timely enrolment on the relevant treatment pathway. Findings suggest that the pathway is feasible and effective, highlighting the need to utilise expertise of clinical scientists in the HF paradigm. Future work should explore long-term feasibility and sustainability of these clinics, further expansion and the feasibility of this service in a district general hospital or community diagnostic centres.