Project Name: Croydon Rapid optimisation Clinic

Project Summary: 

This CWP aims to improve the current hospital-based specialist HF service provided by the CW Partner by creating 2 additional clinics per week run by a Band 7 Heart Failure Specialist Nurse (“HFSN”) and/or Band 7 Specialist Pharmacist with an additional 6 hours administration support per week. These clinics will enable patients recently discharged or are new outpatient referrals, to be seen quickly and started on optimal heart failure medication combinations. Optimising HF patients’ treatment regimes is associated with improved patient QOL and reduced HF hospitalisations. A reduction in waiting times and improved efficiency in lipid optimizing patients will bring the CW Partner in line with other centres in the country. Additionally, CW Partner will establish a business case for future funding of this extension to the Heart Failure (HF) service by the NHS.

Planned Milestones:

CW Partner: Collection of baseline data, in line with the Project Outcome Measures & Data Collection table.

CW Partner: Confirmation of clinical and operational pathway, policy and protocol creation, and readiness to begin the clinical activity (CW Partner shall ensure that the clinical staff covered by the Novartis Financial Contribution are in place, trained and ready to begin clinical activity). Hire purchase  of blood pressure  machines. 

CW Partner: Collection & submission of [3] months clinical activity data. CW Partner and Novartis: Project Review meeting to discuss project progress.

CW Partner: Collection & submission of [6] months clinical activity data. CW Partner and Novartis: Project Review meeting to discuss project progress.

CW Partner: Collection & submission of [9] months clinical activity data. CW Partner and Novartis: Project Review meeting to discuss project progress.

CW Partner: Collection & submission of [12] months clinical activity data. CW Partner and Novartis: Project Review meeting to discuss project progress.

CW Partner: Development of business case, submission of business case by the CW Partner team to relevant body within the NHS Board and submit final CWP report to Novartis within 2 months completion of the clinical work.

Expected Benefits:

Anticipated benefits for Patients 

  • Improved access to evidence based treatment;
  • Increased  equitable and consistent care and access to care.
  • Enhanced experience for patients and their carers who live with HF

Anticipated benefits for the CW Partner

  • Increase the overall quality of care and improve equity of access to specialist care for patients with HF;
  • Increase proportion of patients with HF being managed in accordance with the ESC 2021 chronic heart failure guidelines
  • Reduction in waiting list times 

Anticipated Benefits For Novartis

  • Further opportunities for the appropriate use of cardiology licensed medicines in line with NICE guidelines, including Novartis’s medicine;
  • Improved reputation;Improved professional and transparent relationship and trust between Novartis and the NHS
  • Better understanding of overall customers’ and patients’ needs;

Start Date & Duration: June 2024 for 16 months

UK2402211327

Project Name: Croydon Rapid Optimisation Clinic

Organisation(s): Croydon Health Services NHS Trust

Completion Date: August 2025

Outcome Summary:

Novartis and the Organisation developed a novel tool to facilitate rapid optimisation in a nurse-led heart failure (HF) clinic which has allowed patients to be quickly initiated and optimised to treatment following a HF hospitilaisation, within the European Society of Cardiology1 (ESC) recommended time of 6 weeks and in an optimal manner. A business case for the Trust to fund continuation of the optimisation clinic was not accepted due to current financial pressures, however the Trust have been able to continue delivering the clinic with some re-structuring within the service, but at a reduced level once a week due to the clear benefits to HF patients.

Key Project Outcomes Data: 

  • A total number of 121 patients were seen in 12 months.
  • Average number of weeks to complete titration process was 6 weeks, with an average number of 4 reviews in clinic.
  • 86% of patients were established on 4 pillars of GDMT therapy
  • 98% were established on 3 pillars of GDMTs
  • 14% were on 100% target doses of GDMT
  • On average 74% of target doses of GDMT were achieved
  • 73% of patients had an improved Quality of Life (QoL) score.
  • Low DNA rate of 4%. We are attributing this to the structure of clinic; first 3 appointments confirmed with patients on initial booking. Regular contact/review helped with patient engagement, adherence to appointments and the titration process.
  • There were no admissions within 12 months with decompensated HF or complications from medication titration.

Outcomes:

Measures of success:

  • 100% patients becoming aware of disease or treatment – 100% vs baseline of 70%
  • 100% HCPs becoming aware of disease or treatment - 2 HFNSs are running clinics, all are aware of diagnosis/treatment at initial appointment (project is overseen by consultant cardiologist) vs. Baseline of 70%
  • 70% patients who have accessed a diagnostic test – 100% vs. Baseline of 50%
  • 60% reduction in time for patients referred to the right specialist – 100& vs. Baseline of 70%
  • 60% reduction in time of patients reviewed - 2 to 6 weeks vs. Baseline of 16 weeks
  • 70% of patients optimised on National Guideline directed therapies – 9 months vs. Baseline of 18 mths.
  • 60% improvement in Time to Treatment – 11 weeks vs. Baseline of 12-18 mths
  • Heart Failure Questionnaire offered – 100% (no baseline data available)
  • 70% of patients with access to ongoing care in line with NICE Quality Standards – 100% vs baseline of 70%

Conclusion: 

The Trust developed the tool which facilitated rapid optimisation. 

There were no adverse incidents or admissions as a consequence of rapid optimisation and no admissions with decompensatory HF during the titration process. There was also an improvement in QoL scores. This demonstrates that by adhering to the ESC protocol, patient outcomes can be vastly improved. 

Data for this project was shared in poster format at both national and international HF conferences with great interest from other Trusts HF colleagues. 

A bid to extend the project was declined by the NHS; a business case for the Trust to fund continuation of the optimisation clinic was not accepted due to current financial pressures. 

It would have been the Cardiology teams aim to review longer term data and the follow the outcomes of the patients who were seen in the rapid optimisation clinics for 12 months. The Cardiology teams have been able to continue delivering the clinic with some re-structuring within the Trusts service, but at a reduced level of once a week due to the clear benefits to the Trusts HF patients.

Additional Content: 

A poster was created and presented by the Trusts Cardiology team at the British Heart Failure Congress and the European Heart Failure Congress

References:

1  McDonagh, et al.European Heart Journal. 2023;44:3627-3639

FA-11591378 | April 2026