Heart Failure Hub Scotland: transforming care for people living with the syndrome

The challenge

It is estimated that more than 47,000 people in Scotland are living with heart failure, a figure that is expected to grow owing to population ageing.¹ The syndrome places a considerable burden on both the country’s population and NHS Scotland, the national health service: between 2010 and 2020, the number of annual heart failure hospitalisations increased from 12,000 to 19,000.²

The Scottish government recognised heart failure as a health priority already in 2014, when the National Advisory Committee on Heart Disease (NACHD) advocated for the syndrome’s inclusion in the Heart Disease Improvement Plan.³ However, experts stated that delivering on the commitments in the plan would require a dedicated organisation focused on implementation.⁴ While some clinical groups and centres of excellence were already working to improve heart failure care, their efforts were often siloed, making it difficult to share insights across the country.

The solution

Heart Failure Hub Scotland was launched in 2014 by a group of healthcare professionals involved in the NACHD.⁴ As a subgroup of the NACHD, the hub identifies common challenges, shares findings and drives improvement in heart failure care. It aims to support the implementation of national policy commitments to improving heart failure care.^{1 3}

The hub’s activities are guided by a steering committee comprising healthcare professionals, decision-makers, volunteers and people living with heart failure.⁵ Some of the healthcare professionals act as formal representatives of Scotland’s 14 health boards, the regional bodies responsible for organising and delivering healthcare.⁴ The committee also includes health policy advisors from the Scottish government, establishing direct links to policymakers and the heads of NHS Scotland.

The hub operates across six workstreams:

• Models of care: developing new heart failure care models, and sharing existing ones with the healthcare community.⁶ The hub aims to provide a comprehensive ‘menu of best practice’ on its website to prevent unnecessary duplication of work.⁴ It considers different settings, including urban and rural environments, and primary and secondary care.⁶
• Information and coding: improving the quality of heart failure information included in healthcare records; for example, by developing and sharing coding templates for hospital discharge and primary care which include the cause and type of heart failure.^{4 7}
• Palliative and supportive care: implementing integrated palliative care led by cardiologists and heart failure specialist nurses.⁸ This workstream is funded by the British Heart Foundation and the Scottish government’s Strategic Framework for Action on Palliative and End of Life Care.
• Psychological care: developing clinical pathways for psychological support, improving access to therapy and training frontline staff on the psychological impact of heart failure.⁹
• Quality improvement: supporting health boards with implementing best-practice care to reduce illness and mortality due to heart failure.¹⁰
• Education and training: providing healthcare professionals and people affected by heart failure with educational resources, including a web page and annual conferences.¹¹

These workstreams are typically managed by leading experts in heart failure, who are involved in or are familiar with the hub’s steering committee.⁴

What has been achieved?

The hub works closely with the Scottish government and the heart failure community, helping to implement the Heart Disease Improvement Plan into clinical practice. In 2017, the hub developed national and local business cases for the use of natriuretic peptide testing to diagnose heart failure, which were instrumental in securing reimbursement for the test across Scotland.⁴

In addition, the hub is working with the government to expand the heart failure workforce by increasing pharmacist involvement in the monitoring and adjustment of heart failure medications.⁴

As a national centre for research, information and support, the hub has contributed to research efforts to improve heart failure care, including studies on home-based cardiac rehabilitation and the use of artificial intelligence to reduce diagnostic delays.^{12 13} The hub’s achievements also include implementing the routine assessment of people for psychological distress across all heart failure services in Scotland.¹

Throughout the COVID-19 pandemic, the hub has been a vital source of support for heart failure services and people living with the syndrome.⁴ Healthcare professionals involved in the hub have been able to collaborate and rapidly share the solutions that they have implemented to cope with the pandemic’s impact on heart failure care.

Next steps

The hub’s future priorities align with those in the Heart Disease Action Plan 2021: prevention; timely and equitable access to diagnosis, treatment and care; workforce development; and effective data use.^{1 4}

It will continue working towards reducing waiting times for heart failure services and expanding access to specialist care teams for people who have heart failure with preserved ejection fraction.⁴ In conjunction with coordinators of the National Cardiac Audit Programme, the hub also aims to incorporate heart failure data into the audit from April 2022 onwards.^{1 4}

In 2022, the steering committee hopes to run the hub’s annual patient–carer conference, following cancellations in 2020 and 2021 due to COVID-19.⁴