MANCHESTER— Specialist atrial fibrillation and heart failure virtual wards are helping to keep patients out of hospital by allowing them to be safely managed at home, it was reported at the British Cardiovascular Society Annual Conference.
At the Leicester Atrial Fibrillation Virtual Ward, 127 hospitalisations for fast atrial fibrillation, equivalent to 444 hospital days, have been prevented in the past year alone.
"This is a great opportunity to prevent thousands of hospital admissions each year before they’ve even begun, saving the NHS precious time and money when it needs it most," said Professor André Ng, who heads up the Leicester team behind the initiative.
According to NHS England, there were 340 virtual ward programmes active across all specialities in England as of March 2023. Together these have been able to treat more than 100,000 patients in their own homes in the past year alone.
This is "a real game-changer for the way hospital care is delivered", the NHS' National Medical Director Professor Sir Stephen Powis has previously said .
Virtual wards are part of the 2020-2023 operational plan for the NHS, Professor Powis said at the BCS conference. Their aim is to "deliver care for patients who would otherwise have to be treated in hospital by enabling early supported discharge and providing alternatives to admission".
Leading the Way in Leicester
In Leicester, Professor Ng and team are leading the way for the creation of successful atrial fibrillation virtual wards. He told Medscape News UK: "When we started sharing data, we found that we weren't just Leicester’s first AF clinic, we were the first to start doing this in the world. We've had inquiries internationally from Singapore, from Australia, and New Zealand, wanting to know how we do this. So, it just shows that it is very innovative."
So innovative that the team has recently been awarded more funding from the British Heart Foundation to see how their model might work in other UK centres, and maybe even scaled up to work across the whole of the NHS in future.
Leicester's model is that it is truly a virtual ward, Prof Ng says. Patients receive the same multidisciplinary care and monitoring that they would receive in the ward, just with remote hospital-level monitoring. That includes two ward rounds a day and patients providing blood pressure, ECG, and oxygen saturation readings in the morning and afternoon via a digital platform. Patients are supported via email, telephone, or video calls, and those that do not have smartphones or tablets that are needed to run the system can be loaned a device.
Using this system, medications can be quickly adjusted, Sue Armstrong, who is one of the three advanced clinical practitioners (ACPs) that handle the day-to-day running of the service, told Medscape News UK.
After reviewing the daily data provided by the patients, the ACPs can decide on whether medication such as beta-blockers needs to be altered, and the amended prescription can be available for patients or their family member to pick up from the hospital pharmacy the same day. In some cases, they have been able to arrange delivery of the medication direct to patients, and there are plans to link to an ePharmacy solution via the digital platform soon.
The upshot of all this is that patients are "getting to their destination therapy sooner", Ms Armstrong said. Patients are being empowered and service delivery options are being improved. It’s all about being responsive to patients' needs, she said.
Virtual Heart Failure Wards Gaining Traction
There is no doubt that virtual wards work, and they might be cost saving, but "they are not a panacea; they need to be taken as part of the process and not in isolation", Professor Alun Roebuck , a senior consultant nurse in cardiology at the Lincolnshire Heart Centre based at Lincoln County Hospital, told Medscape News UK.
"We started re-engineering our heart failure pathway 18 months ago and it includes virtual ward, virtual GP, and primary care multidisciplinary teams, so we’re able to transmit specialist care to support primary-care decision making," Professor Roebuck said. Drop-in and at-home frusemide services have also been introduced, he added, as well as community heart failure clinics.
"The net outcome of that is a reduction in [hospital] admissions of 10%, a reduction of re-admissions of 42%," he added. In one year, that amounts to around £1.1 million saved.
In Liverpool, consultant cardiologist Dr Rajiv Sankaranarayanan and colleagues have treated 372 patients in their virtual heart failure ward in the past year, 70% of whom who have had intravenous diuretics either at home or by coming into an ambulatory clinic. Short-term outcomes have shown a reduction in all-cause rehospitalisation at 30 days, from 21% with standard in-ward care to 10.7% with virtual ward care (P=0.003). Of these, 85% of the re-hospitalisations were not due to heart failure.
There was also a reduction in 30-day mortality (14% with standard in-ward care versus 3.8% for virtual ward care, P< 0.001). Yet there was no difference in other outcomes, such as frailty and comorbidity scores.
"We think by managing these patients in a heart failure specialist service, these patients have been taken out of hospital, [have a] reduced risk of hospital-acquired infections, falls, etc. But we're able to optimise the therapies a lot better as well", Dr Sankaranarayanan said at the meeting. "It's very important that heart failure clinicians take the lead and ownership of these patients."
Dr Sankaranarayanan suggested that the virtual ward set up required for heart failure patients might not be cost-saving when compared with in-ward treatment, "but if it’s cost-equivalent and that’s what patients want, then it should be a model of care, and safety obviously is paramount".
Virtual wards only need to be as good as the existing system, agreed one cardiologist sitting in the audience; they do not need to reduce mortality or prove they can achieve better outcomes than those which are currently being achieved, they "just need to be a better way of delivering care" and a "better use of the resources".
Drs Ng, Roebuck, and Sankaranarayanan had no relevant conflicts of interest to report. Ms Armstrong acknowledged receipt of travel grants from Dignio.
