Improved quality of life and a better prognosis for all heart failure patients is the aim of an 11-centre UK programme led in Aberdeen by Dr Martin Cowie, Senior Lecturer in Cardiology and Head of the Cardiology Research Group at the University of Aberdeen. Funded in collaboration with Roche, the Omada Heart Failure Programme is an initiative to audit and improve the quality of care provided to heart failure patients in these 11 centres.
Dr Cowie explained: “Care for patients with heart failure is generally poor. There is a whole combination of reasons for this: patients are primarily elderly, with poor mobility and social support; they are often taking a cocktail of drugs and have other medical problems. All patients need close monitoring however, within current standard NHS structures, close monitoring is difficult to arrange.
“The evidence base for treating such patients is also changing rapidly but it is taking time to get the results of the new research into routine practice. In addition, there tends to be a lack of communication between hospital and primary care services; there is also little out-of-hospital monitoring; and neither the patients nor their family receive advice on appropriate diet, exercise, medication and weight maintenance. This is where Omada comes into play.”
The uniqueness of the programme is that it is a partnership between a pharmaceutical company (Roche) and 11 NHS Trusts across the UK, trying to ensure that the best quality of disease management is provided. This is an holistic programme, tackling investigation, education, follow-up, communication and monitoring. Ten specialist nurses will work in the 11 centres alongside the clinical teams.
The success of Omada will be assessed by comparing audit results in each of the 11 centres, ten months after the start of the programme. Typical of the issues covered will be: how many more patients have had the proper investigations; how many more are on the proper drugs at the correct dosage; how many more have received good advice on how to deal with their disease; and how many have a reasonable quality of life. Heart failure affects quality of life much more than almost any other chronic medical condition.
Dr Cowie added: “This is a real win-win situation. The benefits to the patients are significant: a bench mark for high quality care for this huge group of patients will be established and they will experience the finest level of care from diagnosis onwards. The NHS will be able to offer a better quality of care and there will be a reduced need for hospital admission and the families will feel empowered in looking after their relatives properly”
In patients suffering from heart failure, the heart is damaged and no longer able to work as an effective pump. The patient is breathless, tired and suffers from fluid retention. In addition, the overall quality of life is low and life expectancy is poor, with less than half of patients still active more than three years after diagnosis.
The disease is a major drain on NHS funding: it demands 1% of the health care budget (some £400m); it is the cause of 5% of emergency admissions (120,000 per year); and there has been a steady increase in the number of hospitalisations over the past 20 years.
At the beginning of the 1990s, there were three main treatments for heart failure patients: diuretics and digoxin which help improve symptoms and angiotensin converting enzyme inhibitors which help improve symptoms and also aid prognosis.
In the late 90s, it became clear that treatment with ß-blockers, such as Carvedilol, was particularly beneficial. The majority of patients with heart failure in the UK have yet to benefit from this new evidence: the Omada programme helps ensure that all patients will benefit from such new knowledge.