Chest Heart & Stroke Scotland: Care at home keeps down hospital admissions

HEART failure deserves better. We’re so used to apocalyptic stories about Scotland’s health that we sometimes miss the good news.

Picture: TSPL

For example, over the past ten years we’ve seen a rapid and sustained fall in our death rate from heart disease – by 43 per cent between 2002 and 2012. According to the most recent national statistics, Glasgow has even lost its No 1 spot as the heart attack capital of Britain.

This means, of course, that thousands of Scots who, a decade ago, would have died from heart disease are now living with this as a long-term condition. A consequence of this, and our ageing population generally, is a steady rise in the number of people affected by heart failure. There are now more than 94,000 people living with this condition, and they’re getting a raw deal.

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“Heart failure” is a frightening term, particularly if you or a loved one has just received a diagnosis. It describes a condition where the heart muscle has become weakened, and can’t pump the blood around the body as efficiently as it once did. If you’ve reached 80, your heart has probably beaten about three billion times over the course of your life, so it’s not really surprising that some hearts weaken with age. Heart failure affects about 2 per cent of the population, but this rises to 15 per cent in the over-85s.

The symptoms vary, but most commonly include tiredness and lack of energy, shortage of breath, swelling of the feet or ankles, heart palpitations and chest tightness, memory and concentration problems, and sleep disturbance. Not surprisingly, patients can become isolated and prone to depression.

While we don’t have a cure for heart failure, modern surgery, drugs and support can make a real difference to patients, relieving symptoms and helping people achieve their best possible quality of life. Most patients are able to live at home with support, particularly from NHS heart failure nurses.

The role of the heart failure nurse is particularly important. By helping patients understand their symptoms, and why these might vary, and self-manage their often complex drug regimes, they can support patients to carry on living at home rather than have to be admitted to hospital.

This doesn’t just save the NHS money but, more importantly, it’s what patients want. Particularly where the nurse operates in partnership with the volunteer befriending service offered by Chest Heart & Stroke Scotland, patients can be supported at home who would otherwise be at real risk of admission to institutional care.

Unfortunately, the NHS in Scotland is not funding enough heart failure nurse posts. The latest national audit showed that, in spite of an increasing demand for the service, there was actually a reduction of 7 per cent in the number of posts between 2008 and 2012.

Of the 14 Scottish NHS boards, only three saw any increase in the service at all, and some of the largest, including Greater Glasgow & Clyde and Lothian, saw a reduced level of service. Only four of the 14 boards meet the minimum target for number of nurses laid down in national guidelines. In virtually all of Scotland, the average caseload for a specialist heart failure nurse exceeds the recommended maximum. The problem is exacerbated by cuts in administrative support, which means that less of the specialist nurses’ time is available for direct patient care.

A range of audits has shown the community-based heart failure nurse is one of the most cost-effective services the NHS can provide. An audit of one of the longest-established services in Scotland showed that, over a ten-year period, the support of a heart failure nurse generated a 44 per cent cut in hospital admissions and a 20 per cent reduction in length of stay for those who were admitted.

A large national audit in England generated similar results – only 18 per cent of patients with a heart failure nurse were readmitted to hospital, compared with 97 per cent of similar patients who didn’t get this service. The net saving, even after allowing for the costs of employing the nurses, was more than £1,800 per patient per year.

The NHS in Scotland is under pressure to reduce unnecessary hospital admissions and support people to get home as safely and quickly as possible. These pressures only will increase as our population ages and the numbers living with complex long-term conditions continues to grow. Specialist heart failure services support people to stay at home, bring in support from the voluntary sector, save the NHS money and, most important, reflect what patients want. Holyrood is debating the issue later this month and MSPs should be urging that we expand, rather than reduce, this vital service.

• David Clark is chief executive of Chest Heart & Stroke Scotland