CWM TAF COMMUNITY CARDIOLOGY AF PALPITATION PROJECT Justin

CWM TAF COMMUNITY CARDIOLOGY AF / PALPITATION PROJECT Justin Taylor Consultant Cardiologist

Background � 2015 - £ 1 m allocated to Heart Disease Implementation Group for community cardiology transforming pathway initiatives � Money allocated to each Health Board on a proportional population basis (£ 95 k for Cwm Taf) � Each Health Board developed own initiatives based on current service provision and local population needs

� Cardiac Network funded GPw. SI training �Cwm Taf 3 GPs � Cwm Taf Successful Health Technology fund application for £ 149 k � GP backfill funded from Primary Care

Cwm Taf model proposal � Low risk AF and palpitations � Short waiting time � One stop clinic with little requirement for F/U � Investigations done on same day

Anticipated benefits � Reduced referrals to secondary care � Improvement in RTT � Reduction in patient anxiety � Reduced acute admissions hospital

Process flowchart GP consultation in GP Practice Referral to community clinic using WCCG Triaging of GP referrals in Secondary Care Patient phoned + appointment letter AF clinic ECG + Echo Palpitation clinic ECG (+ Echo) Ambulatory monitoring + Investigations arranged Follow-up in Secondary care Discharged Follow-up in Community clinic

Cwm Taf model � Fortnightly clinics in Keir Hardie Health Park � 2 GPw. SI + Arrhythmia nurse � Echo physiologist � ECG/monitor physiologist � Cardiology consultant � Started End of November 2016

Monthly referral rate 45 40 35 30 25 AF 20 Palpitation Total 15 10 5 0 Nov Dec Jan Feb Mar Apr May Jun

Monthly Activity rate 60 50 40 AF 30 Palpitation Total 20 10 0 Nov Dec Jan Feb Mar Apr May Jun

Referral vs Activity 50 45 40 35 30 25 Referral 20 Activity 15 10 5 0 Nov Dec Jan Feb Mar Apr May Jun

Clinic Outcomes � Number of appointments � Number of attendances � DNA rate 197 176 11% � ECG 176(100%) 109 (62%) 136 (77%) � ECHO � Ambulatory monitor

Clinic Outcomes � Number of attendances � Number of discharges after Ix 176 � Long 4 ~10 2 3 term rhythm management � Long term valve monitoring � UHW arrhythmia � Cardiac CT � Angiogram � DSE

Clinic Outcomes � Other diagnoses �Mod/severe heart failure �SVT �Dilated Aortic root � Readmission to A&E afterwards � Re-referral to secondary care � Death 2 4 2 3 0 2

Summary � 176 low risk AF/Palpitation patients seen � Rapid appointment - waiting time 4 weeks � Rapid Ix - most Ix done on the day � Low rate of secondary care follow-up – approx 9% � Very few admissions to A&E with same problem – approx 2% � Effectively saved 19 consultant DCC sessions worth of OPD activity in 8 months (nearly 3 weeks)

The future � Patient � Full satisfaction questionnaire cost analysis � Vision 360 � Expand population group covered

The Team Annie Hughes, Laura Lewis � Imran Gilani � � Dave Tyler/Catherine Templeton Susan Nolan/Lalit Bhalla/Gobi Navaratnum � Bikram Chowdhary/Shyama Velupillai/Gafyn Rees � Paula Yeo �