An innovative community based Cardiac Diagnostics Service prevents hospital

attendances

PG. Nolan1, O. Harrington2, J. Barton3, BD. MacNeill1, JJ. Crowley1, PJ. Nash1, K. Daly1

(1) University Hospital Galway, Galway, Ireland (2) Croi Rapid Cardiac Diagnostics, Galway, Ireland (3) Portiuncula Hospital, Galway, Ireland

Background

Background

Echocardiography Cardiac Ultrasound Primary tool for

diagnosis and follow-up Heart Failure Valvular Heart Disease Structural Heart Disease

Sudden Cardiac Death Paediatric to Geriatric

Service National Clinical

Programs Acute Medicine Heart Failure Acute Coronary

Syndrome

Background

Primary Care Physicians (GP's) have limited access to diagnostics Only 22% have open access

As part of the Community Heart Failure Program (ChaMP) Community based Echocardiography Service

commenced (Sept 2008) Croi, the West of Ireland Cardiac Foundation HSE West PCCC Cardiology Departments

University Hospital Galway Portiuncula Hospital

Eur Heart J 2000; 21: 1877–1887

Background

Now extended to include

Echocardiography 24hr-7 day Holter

monitoring Ambulatory BP

monitoring The only community

based Cardiac Diagnostics Service to GP’s in the Republic of Ireland.

Methods Sept 2008 - Sept 2012 3015 cardiac investigations were

performed by the service. 2249 patients underwent

echocardiography accredited Echocardiographer GE Vivid-i portable echo machine

Holter and Ambulatory BP monitor service commenced January 2011

570 patients underwent Holter monitoring 24hours to 7 days

196 had Ambulatory BP monitoring.

Referrals

47.1% of referrals were for reasons commonly seen in acute medicine Dyspnoea Cardiomegaly Palpitations suspected heart failure.

All patients had their test performed within 4 weeks of referral with urgent cases receiving highest priority

Results

47.8% of tests were reported as normal Echocardiography results

12.1% of patients had reduced LV function 5.8% mild dysfunction 2.9% moderate dysfunction 3.2% severe dysfunction.

33.3% of patients significant valvular disease

15.4% of cases at least moderate disease

Patient journey

Only 8% of tests required rapid direct referral to the Cardiology Outpatient Clinic

three cases attended the ED/MAU

92% of cases managed by GP's

Estimated savings

In absence of service OPD referral MAU/ED referral

GUH expects ED/MAU attendances - 22%

estimated direct cost of an ED attendance €162 OPD – 78%

estimated direct cost of an OPD attendance €167

Cost of an echocardiogram - €165

Estimated savings

Estimated cost of ED attendances 663 x €162 331 x €165 Total € 162021

Estimated cost of OPD attendances 2352 x €167 1176 x €165 Total €586824

Total saving

Challenges

Lack of perceived value in the normal test

Funding Peer-review and audit Increasing referral rate

Conclusion