Home is Where the (Failing) Heart is

As the population ages, more people will be living with heart failure. So could a pilot project in Rotherham be the key to keeping these patients at home, rather than in hospital?

Britain’s population is ageing. On paper, that sounds like medical progress. But the harsh reality is many people who live longer than their predecessors won’t necessarily have the quality of life to match.

And one key area where this is likely to manifest itself is heart failure.

Although the chances of surviving a heart attack – one of the main causes of heart failure – are probably greater than ever before, many survivors are left with seriously depleted heart function which takes a huge toll on their quality of life as they age.

After a heart attack the heart may adversely remodel or change shape and as a consequence of this is less able to pump blood around the body as effectively as it did before the heart attack.

Around 65,000 people a year in the UK develop heart failure as a result of a heart attack.

This may lead to symptoms such as shortness of breath, fluid retention with associated leg or abdominal swelling, and severe tiredness.

Although there are drugs that can improve the function of the damaged heart and help to lengthen life, some people may deteriorate, and prognosis of heart failure is often poorer than that of most cancers.

A revolutionary new approach to treatment is being pioneered by the Rotherham Heart Failure Team which could, potentially, transform the way that patients with severe heart failure are cared for.

The Yorkshire town has over 2,000 patients on its heart failure register, although it is thought this number is considerably higher.

One of the most important drugs used to relieve the symptoms of heart failure is a tablet called a diuretic. This works by stimulating the kidneys to get rid of excess sodium and fluid. This in turn eases the symptoms of breathlessness, swelling, and any associated discomfort.

However, in some instances diuretic tablets do not work and people need to be admitted to hospital to have the drug administered intravenously.

An average hospital stay for treating symptoms of heart failure is 11 days. Many people with heart failure in Rotherham have indicated that they would rather be cared for at home.

In recent years there have been initiatives looking at delivering intravenous diuretics to people within the home but these have been restricted by the need to use electronic pumps. Because the pumps can malfunction this necessitates the presence of a nurse while the drug is being admistered. Because of time constraints patients would only be able to receive bolus doses of the drug over 20-30 minutes.

Many people with advanced heart failure have problems with very low blood pressure and poor kidney function. This limits the use of bolus dose intravenous diuretics. These patients normally need to go to hospital to have the drug delivered via an electronic pump continuously at a low dose over a 24 hour period.

Staff at Rotherham are now initiating a programme where patients can stay at home and receive IV therapy through an elastomeric pump supplied by CME Medical – known as MyFuser.

The beauty of elastomeric pumps is that they do not require a power source and so require less supervision.

It also means they can be mobile, allowing patients more freedom while receiving their medicines – rather than being plugged into a wall at home.

Inside each pump is an elastomeric layer which is fully stretched once filled with the drug solution.

As this layer then constricts, it pushes the liquid drug through the tubing at a precise rate and then through a flow restrictor into the patient connection.

The pressure is consistent, which ensures a controlled flow of medicine, and because they are not gravity-driven, there is no need to keep them elevated. These pumps are known for their reliability because there are no electrical or mechanical parts to go wrong.

The Rotherham initiative is using MyFuser technology to allow patients to have a better quality of life, rather than frequently journeying to hospital for treatment.

The MyFuser pump is not only efficient but discreet enough that it can be clipped on to the patient’s belt while they go about their normal daily activities.

The heart failure team are currently putting together a business case for using elastomeric pumps to keep patients in their own homes. Although numbers of people who are currently being admitted to hospital purely for IV diuretics are not huge they are almost certain to increase as people get older.

The heart failure team recognise that there is a significant cost saving to be made in keeping patients in their own home rather than be admitted and treated in hospital.

One of the problems with heart failure patients is they tend to have longer hospital stays than general medical patients.

More importantly, it means an awful lot to patients to be able to remain in their own home.  Many patients have indicated that they often struggle to sleep at night when in hospital or are concerned because family members may have to travel to visit them.

The heart failure team believe that projects like the Rotherham initiative will help to improve the quality of life for heart failure patients as well as freeing up hospital beds for patients who really need them.

The Rotherham heart failure team are keen to stress that patients are very carefully assessed prior to commencing on the MyFuser pump in order to ensure patient safety and effective delivery of the diuretic drug. Therefore, the MyFuser may not be considered a suitable treatment for all patients. The Rotherham heart failure team have stated that‘Patients have told us this is what they want and that they don’t want to keep going into hospital.’ But for those who tick the right boxes and for the NHS, it makes perfect sense.

‘This is definitely worth pursuing – it’s the way forward.’

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