The vision for this program is to intervene at a primary care (general practice) level to improve patient outcomes and reduce healthcare costs by reducing preventable admissions. If found feasible and effective, this suite of interventions has the potential to save up to $30 million annually if implemented across NSW.
Heart failure is a progressive, chronic disease that is often marked by frequent hospitalisations and is associated with a high mortality rate. In NSW alone, associated healthcare costs are estimated at $1 billion/year, mainly related to hospitalisation costs. Within 30-days of a first heart failure admission one third of surviving patients will be readmitted. Additionally, 5 year mortality after the first heart failure admission is 50 per cent, similar or even worse than many cancers. In Hunter New England Local health District, the annual rate of death or re-admission following heart failure hospitalisation is 69 per cent.
NSW’s Agency for Clinical Innovation, via its Cardiovascular Clinical Expert Reference Group, has identified heart failure service delivery as a key area for improvement. It has published NSW clinical service framework for chronic heart failure this year, directing us to improve heart failure management. Many individuals are not diagnosed with heart failure in a timely manner, and once a diagnosis is made, treatment is frequently sub-optimal resulting in adverse outcomes and unnecessary costs.
We are proposing to implement a combination of interventions in the primary health care setting to improve access to heart failure services and management, especially for patients in rural and remote areas. We will test the feasibility, acceptability and potential effectiveness of this strategy in a primary care based intervention study across a full range of rural settings in Hunter New England and Central Coast local health districts. The intervention involves a one-day general practitioner education “masterclass”, NT-proBNP monitoring, patient-centred daily heart failure diary and home-based heart failure exercise program.
Collaborators: Agency for Clinical Innovation, Hunter New England and Central Coast Primary Health Network, Bonnells Bay Surgery