{
  "abstract": "Introduction 200,000 new cases of heart failure (HF) are diagnosed annually in the UK, with cases expected to double by 2040. Acute HF is a leading cause of hospitalisation over 65s, with 50% five-year mortality rate after first HF hospitalisation. Timely treatment reduces morbidity and mortality, with urgency of diagnosis reflected in guidelines. NICE recommend transthoracic echo (TTE) within 2 weeks if N-terminal pro-B-type natriuretic peptide (NT-proBNP, hereafter ‘BNP’) is >2000 ng/l, or within 6 weeks if BNP is 400 – 2000 ng/l. At our centre, which serves a population of 544,000, we identified the need to improve our HF diagnostic pathway.Method Launched in 2022, the Rapid Access Heart Function Clinic (RAHFC) provides a one-stop BNP-gated service for suspected HF, akin to a two-week-wait cancer pathway. All referrals are triaged by a HF clinician, with uncontrolled atrial fibrillation and established HF excluded. Audits were conducted in Autumn 2021 (pre-RAHFC) and 2023 (post-RAHFC) to evaluate wait times to TTE and HF clinician review. All referrals into general cardiology outpatients over a 2-month period were screened. Referrals mentioning signs/symptoms of HF, raised BNP and/or abnormal TTE were included in audits, alongside those explicitly stating a differential of HF.Results In 2021, 97 referrals with possible HF were received over 2 months. In 2023 there were 103. The majority were referred by a GP (91% in 2021, 82% in 2023) with the remainder from other specialities, A&E or ambulatory care. In 2021, 44% had BNP >400 ng/l, with 28% <400 ng/l and 27% unknown. In 2023, 59% had BNP >400 ng/l, with 10% <400 ng/l and 31% unknown. In the ‘BNP unknown’ group, around a third had TTE prior to referral. Of referrals with BNP >400 ng/l (n 105), 45.7% were diagnosed with HF (25.7% had ejection fraction <50%). The remainder had other cardiac (30.5%) or non-cardiac (21%) diagnoses. For patients referred by a GP or as an outpatient from other speciality, median wait time to TTE (days) reduced from 152.0 (IQR 37.0 – 250.0, n 59) to 23.5 (IQR 13.8 – 38.3, n 68) ( figure 1 and figure 2). Wait time to clinician review (days) reduced from 121 (IQR 33.5 – 130.5, n 71) to 27 (IQR 18 – 68.25, n 78). In 2023, 26 patients (28% of those seen) were seen in the RAHFC, with median wait time 18 days (IQR 15 – 28).Abstract 5-005 Figure 1Median time to TTE pre RAHFC (2021)Abstract 5-005 Figure 2Median time to TTE post RAHFC (2023)Conclusions RAHFC implementation was associated with a reduction in TTE and clinician review wait times, improving timely HF diagnosis and treatment. Whilst post-pandemic recovery is an important confounder, reduced wait-time variability reflects better standardisation. Over half referred with possible HF and BNP >400 ng/l had a non-HF diagnosis, highlighting challenges in triaging. Further work will focus on improving awareness of the service and ongoing collaboration with care of the elderly colleagues to optimise our approach in frailer patients.",
  "authors": [
    {
      "affiliations": [
        "Somerset NHS Foundation Trust, UK"
      ],
      "name": "O Basquill"
    },
    {
      "affiliations": [
        "Somerset NHS Foundation Trust, UK"
      ],
      "name": "R Sukumar"
    },
    {
      "affiliations": [
        "Somerset NHS Foundation Trust, UK"
      ],
      "name": "N Adaza"
    },
    {
      "affiliations": [
        "Somerset NHS Foundation Trust, UK"
      ],
      "name": "K Hyde"
    },
    {
      "affiliations": [
        "Somerset NHS Foundation Trust, UK"
      ],
      "name": "B McKee"
    },
    {
      "affiliations": [
        "Somerset NHS Foundation Trust, UK"
      ],
      "name": "S Roy"
    },
    {
      "affiliations": [
        "Somerset NHS Foundation Trust, UK"
      ],
      "name": "A Burchell"
    }
  ],
  "title": "5-005 Impact of a rapid access heart function clinic on timely diagnosis of heart failure in a large district general hospital",
  "uid": "4963fa70-67b0-51fd-9397-4a68c5de962d"
}