Project Name: Heart Failure In-reach Pharmacist St George’s University Hospitals
Organisation(s):
Novartis Pharmaceuticals UK Limited, 2nd Floor, The WestWorks Building, White City Place, 195 Wood Lane, London W12 7FQ, and,
St George’s University Hospitals NHS Foundation Trust
Project Summary:
The main objective of the Collaborative Working Project is to improve the quality of care delivered to Heart Failure (HF) patients under the care of the St George’s University Hospitals NHS Foundation Trust (The” Trust”) in line with European Society of Cardiology ESC guidance1. This CWP will involve the improvement of the current hospital-based specialist HF service at the Trust through the deployment of an “in-reach” pharmacist HF specialist. Additionally, the CWP aims at establishing a case for future funding of the HF service by the Trust. The project will be looking to improve against the baseline % measures for The Trust – patients receiving/being prescribed (including all patients admitted with less than 24 hours admission):
- input from specialist;
- received discharge planning;
- referral to HF specialist
- Implementation of the local treatment protocol;
- Patient education of Heart Failure with a personalised Care Plan
Planned Milestones:
Milestone | Description |
---|---|
1 | Confirmation of the employment of pharmacist ; pharmacist on-boarding and familiarisation; complete collection of baseline aggregate comparator data for the project outcomes. Implement in-patient strategies/protocols and procedures governing the clinical operations of the HF Service. Begin clinical operations according to the developed protocols, monitor and collect data. |
2 | Carry out 3 months of clinical operations according to the developed protocols, NHS Trust to monitor and collect data, provide anonymised report. |
3 | Carry out 3 months of clinical operations according to the developed protocols, NHS Trust to monitor and collect data, provide anonymised Submission of business case by SGUH HF team to relevant body within SGUH |
4 | Carry out 3 months of clinical operations according to the developed protocols, NHS Trust to monitor and collect data, provide anonymised |
5 | Carry out 3 months of clinical operations according to the developed protocols, monitor and collect data, provide anonymised report |
6 | Carry out 3 months of clinical operations according to the developed protocols, monitor and collect data, provide anonymised report |
7 | Carry out 3 months of clinical operations according to the developed protocols, monitor and collect data, provide anonymised report |
8 | Submit final CWP report to Novartis within 6 months completion of the clinical work |
Expected Benefits:
For the Patient:
- Improved access to evidence based treatment;
- more equitable and consistent care and access to care.
- enhanced experience for patients and their carers who live with HF.
- Increased access to Education on heart failure will enable patients to self manage their condition
- A personalised heart Failure care plan will help the patient to self manage their condition
For the NHS:
- Increase the overall quality of care and improve equity of access to specialist care for patients with HF;
- Increase proportion of patients with HF being managed in accordance with the ESC 2021 chronic heart failure guidelines
- Reduction in waiting list times
For Novartis:
- Further opportunities for the appropriate use of cardiology licensed medicines in line with NICE guidelines, including Novartis’s medicine;
- Improved reputation;
- Improved professional and transparent relationship and trust between Novartis and the NHS
Start Date & Duration: September 2022 for 24 months
UK2308241147
02-Aug-2023
Project Name: Heart Failure In-reach Pharmacist St George’s University Hospitals
Partner Organisation(s): St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT
Completion Date: September 2024
Outcome Summary:
This project has achieved its main objective of aiming to improve the quality of care delivered to Heart Failure (HF) patients under the care of the St George’s University Hospitals NHS Foundation Trust (The” Trust”), in line with European Society of Cardiology ESC guidance1. Furthermore, the collaborative working helped facilitate a wider expansion of heart failure services.
Key Project Outcomes Data:
Key outcomes have included:
- Reduced waiting times for medication optimization clinic review from 30 weeks to the current times of 2-3 weeks.
- Establishment of, on average, 2 additional medication titration clinics per week led by the pharmacist or involving the pharmacist with other members of the wider multidisciplinary team.
- Enhanced ability of the heart failure nurses to offer greater levels of support to patients.
- Service improvements including the formation of a dedicated heart failure outpatient intravenous iron infusion service, offering not only iron infusion, but a medication and symptom review for patients.
Outcomes:
This collaborative working project has enabled an expansion in the hospital-based medication titration clinics which has led to two improvements, firstly a reduction in the waiting list from 30 weeks to currently 2-3 weeks, as well as increasing capacity to allow the department to progress with prescribing for patients during their inpatient admissions.
The heart failure team have also been able to commit more resources to offer further heart failure in-reach services to improve the equity of access to specialist input. This has led to patients presenting to cardiology services for other cardiac conditions, other than heart failure, and receiving access to medications if evidence of heart failure is detected during the admission. It has also meant that patients have greater access to long term support through the community heart failure nurses through reliable identification, and referral of suitable patients.
Beyond this the pharmacist role has allowed the heart failure team to establish a joint pharmacy-nurse led IV iron service. The use of dedicated heart failure staff ensures not only does the patient receive an iron infusion, but also an assessment of their symptoms and a review of their other heart failure medications, ensuring every visit counts towards optimising treatment.
The role has also allowed us to implement more fully the ESC Heart Failure guidelines. One recommendation is for services to move towards a process of rapid initiation and titration of evidence-based therapies for patients with heart failure, regardless of their ejection fraction, in line with the STRONG HF Clinical trial reported in the Lancet in 2022. Our extra clinic capacity allowed us to achieve this, meaning that eligible patients receive optimised doses of recommended guideline direct medical therapy within 6 weeks, as opposed to 6- 9 months.
The CW partner heart failure team feel that the improved services they can now deliver will have impact on both cardiology services, and other clinical services throughout the Trust. It is expected that these developments will lead to a reduction in overall readmission rate and reduce caseloads in medicines optimisation clinics, due to new and optimised methods of working.
Quote from Partner:
"The collaboration with Novartis has been a hugely beneficial experience. The joint nature of working with Novartis has allowed us to ensure we have got the maximum benefits out of the pharmacy role through the collaborative working agreement.
The project team at Novartis have helped us to remain focused to ensure we met the milestones and regularly reviewed project metrics with us to ensure we were progressing well.
The Novartis team have been incredibly supportive and understanding of the pressures faced when providing clinical services, and it has felt like a true collaboration. It has been a pleasure to work with the team to be part of the project, which undoubtedly has brought improvements to patients living with a diagnosis of heart failure in our locality.
On behalf of the team at St George’s I wish to thank all involved for helping us deliver a successful collaboration which ultimately has allowed us to deliver far more than the initial expectations of the project."
Matt Sunter – Lead Heart Failure Nurse – St George’s University NHS Foundation Trust.
Conclusion:
This project has been extremely valuable in terms of helping to interact with many more patients with heart failure than before the collaborative working agreement.
Additional Content:
Whilst the CW partner has not yet formally published any outcomes from the project we are working towards a poster presentation at the European Society of Cardiology Heart Failure Association congress in May 2025.
References:
Mebazaa A, Davison B, Chioncel O, Cohen-Solal A, Diaz R, Filippatos G, Metra M, Ponikowski P, Sliwa K, Voors AA, Edwards C, Novosadova M, Takagi K, Damasceno A, Saidu H, Gayat E, Pang PS, Celutkiene J, Cotter G. 2Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial. Lancet. 2022 Dec 3;400(10367):1938-1952. doi: 10.1016/S0140-6736(22)02076-1. Epub 2022 Nov 7. PMID: 36356631.
McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A; ESC Scientific Document Group. 2021 1ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-3726. doi: 10.1093/eurheartj/ehab368. Erratum in: Eur Heart J. 2021 Dec 21;42(48):4901. doi: 10.1093/eurheartj/ehab670. PMID: 34447992.
FA-11377303 | March 2025