Where does palliative care for patients with heart failure fit into the Scottish agenda for heart disease Advanced Heart Failure Symposium RCPSG 22 nd November 2012 Dr Barry D Vallance Lead Clinician for Heart Disease, Scotland Chairman of the National Advisory Committee for Heart Disease
Days spent in hospital by diagnosis
Heart Failure in Scotland It is thought that there may be as many as 100,000 people in Scotland living with heart failure at present, resulting in very significant increases in the numbers (and costs) of prescriptions for heart failure drugs over recent years Costs in this area rose from ~ £27m in 2000-01 to ~ £44m in 2006-07
Action Plan – June 2009
Heart Disease • Improving Heart Failure Services – Sections 4.34 4.35 4.36 and 4.37 and 4.39 to 4.46 • Improving Palliative Care – Sections 4.47 to 4.53 • Improving psychological support for Advanced Heart Failure – Sections 4.69
SIGN 95 CHF • SIGN Guideline 95 on the management of chronic heart failure has a section on palliative care that includes a clear recommendation: that a palliative care approach should be adopted by all clinicians managing people with chronic heart failure from the early stages of the disease . • The recommendations in the Guideline have been incorporated into the NHS QIS clinical standards on the prevention and treatment of heart disease.
Heart Disease Clinical Standards NHS QIS - April 2010
Clinical standards for heart disease Supportive and palliative care for patients with heart disease • Standard 18 Supportive and palliative care for patients with heart disease
Heart Disease Clinical Standards NHS QIS - April 2010 • Standard 18 states that patients who remain symptomatic despite optimal treatment/maximum tolerated therapy are identified and offered a supportive and palliative care approach. • It is essential that people with advanced heart failure are included on the palliative care register in each general practice, their care needs assessed and care planned to meet those needs.
Palliative Care Directed Enhanced Service (DES) • In November 2008, a Palliative Care Directed Enhanced Service (DES) was introduced in Scotland. This emphasised the importance of including all patients with palliative care needs (not just those with cancer) on the GP palliative care register. The DES also requires practices to compile a care plan for such patients and to ensure that a summary of this is made available to OOH services. An electronic Palliative Care Summary (ePCS) is to be piloted.
Palliative Care Directed Enhanced Service (DES) • Action: NHS Boards’ cardiac and palliative care MCNs should jointly undertake an audit of practices’ implementation of the palliative care DES, and collaborate to ensure implementation of Boards’ Living and Dying Well Delivery Plans. • Managed Clinical Networks Many of the cardiac networks have already demonstrated success in improving palliative care for people with HF.
Living and dying with advanced heart failure: a palliative care approach • In March 2008, the Scottish Partnership for • Palliative Care (SPPC) and the BHF Scotland published Living and dying with advanced heart failure: a palliative care approach . • The report responded to a recommendation in the CHD and Stroke Strategy in 2001 that provision should be made to meet the palliative care needs of people with end-stage heart failure.
Living and Dying Well • Scotland’s first national action plan for the provision of palliative and end of life care was published in October 2008. This action plan describes palliative and end of life care as integral aspects of the care delivered by any health or social care professional, focusing on the person, not the disease, and applying a holistic approach to meet the physical, practical, functional, social, emotional and spiritual needs of patients and carers facing progressive illness and bereavement. http://www.Scotland.gov.uk/Publications/2008/10/0 1091608/0
Living and Dying Well • All NHS Boards have now submitted delivery plans against the Actions in Living and Dying Well which aim to provide services for those patients with palliative and end of life care needs, irrespective of diagnosis, and which incorporate the recommendations from the SPPC report Living and dying with advanced heart failure: a palliative care approach .
Living and Dying Well • As well as being core components of Living and Dying Well these specific initiatives are key enablers of improvements to support individuals and their families. In summary, this report, Living and Dying Well; reflecting on progress , confirms and reinforced the view that these areas remain priorities.
Living and Dying Well: Building on Progress • The progress report sets out the next actions to support delivery for NHS Boards to undertake, which include: • Early identification of patients who may need palliative care • Advance/anticipatory care planning • Palliative and end of life care in acute hospitals • Electronic palliative care summary (ePCS) • Do not attempt cardiopulmonary resuscitation (DNACPR)
Marie Curie and BHF - Caring Together • The creation by the British Heart Foundation and Marie Curie Cancer Care of a centre of excellence in Glasgow, and their investment in research and development for those with advanced heart failure, represents a major contribution. A Marie Curie Cancer Care and British Heart Foundation collaborative project, working together with NHS Greater Glasgow & Clyde, aims to develop equity of access to palliative care services for cancer and cardiac patients.
Marie Curie and BHF - Caring Together The project aims to:· • meet the needs of patients and carers • complement the optimal management of heart failure (and other diagnosed conditions) • promote equity of access to palliative care for heart failure patients • acknowledge the patient’s preferences in place of care, including home • enable increased choice of place of care for patients • improve coordination of care among stakeholders
National Heart Disease Conference (Celebrating Success) Friday 28th October 2011 • The SG sponsored a National Heart Disease Conference (Celebrating Success) which included a number of presentations and posters on innovative and successful approaches to the provision of people with HF palliative care for people with HF . This showed that there are a number of areas where there excellent examples of redesign and innovative practice taking place.
NACHD • Professor Scott Murray presentation to NACHD The NACHD invited Professor Scott Murray to provide a report on palliative care for patient with heart failure. He highlighted the fact that while HF patients had a worse prognosis than cancer patients there were very few on the Palliative Care register. The Committee agreed that this needed attention and we have asked the cardiac MCN's to consider this issue in more detail .
NACHD • New Heart Failure subgroup of the NACHD to be formed • Chaired by Dr Mark Petrie • To drive forward the entire Heart failure Agenda including Palliative Care • Develop National Heart Failure Research Group
Advanced Heart Failure Symposium RCPSG 22 nd November 2012 Where does palliative care for patients with heart failure fit into the Scottish Government agenda for heart disease? High on the Scottish Government’s agenda but not high enough in everyday clinical practice . Today’s event clearly demonstrates the enthusiasm and major interest in Palliative Care for Heart Failure. We all need to spread the word and deliver what we have discussed and learned here today.
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