Background Heart failure (HF) is an increasingly prevalent condition associated with poor quality-of-life and high symptom burden. Patients experience an unpredictable disease trajectory and repeated acute admissions towards the latter stages of life. As patients reach ceilings of survival-extending interventions, their priorities may be more readily addressed through the support of palliative care services, however the best model of care remains unestablished.
Objectives We aimed to create and evaluate a co-specialty cross-boundary service model for HF patients that better provides for their palliative care needs in the latter stages of life, whilst delivering a more cost-effective patient journey.
Methods In 2016 the Heart Failure Supportive Care Service (HFSCS) was established to provide patient-centered holistic support to advanced HF patients. Patient experience was evaluated through questionnaires that were developed and distributed in mid-2018 and end-of-2020. Actual and indexed hospital admission data (in-patient bed days pre-/post-referral) were used allowing statistical comparisons by paired student t-tests. Cost mapping analysis allowed approximation of cost-saving benefits.
Results From 2016–2020, 236 patients were referred to the HFSCS. Overall, 75/118 questionnaires were returned. Patients felt the HFSCS delivered compassionate and coordinated care (84% and 80%) that improved symptoms and quality of life (80% and 65%). Introduction of the HFSCS resulted in a statistically significant reduction in HF-related admissions: actual days 18.3 to 4 days (p<0.001), indexed days 0.05 to 0.032 days (p=0.03), and a 50% reduction in hospital deaths over 5 years. Cost mapping revealed an estimated average saving of at least £10,218.36 per referral and a total estimated cost saving of approximately £2.4 million over 5 years.
Conclusion This service design demonstrates that a co-specialty cross-boundary method of care delivery can successfully provide the benefits of palliative care to HF patients in a value-based manner, whilst meeting the priorities of care that matter to patients most.
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