WINNER: Supportive Care: A Value-Based Approach to Palliation in Advanced Heart Failure

Cardiff and Vale University Health Board

There is huge inequity of access to Palliative Care in the UK, mostly on the basis of diagnosis, with around 88% of Specialist Palliative Care inpatient provision and 75% of outpatient / hospital support currently prioritised to cancer patients. In the last 1-2 years of life, conditions such as heart failure have a similar symptom burden to metastatic cancer, with equal levels of distress which palliative care input could help. However, patients dying from causes other than cancer are disadvantaged with only 20% ever receiving Specialist Palliative Care.

Over the last six years, Cardiff and Vale University Health Board have developed a new Supportive Care service to better deliver palliative care input to patients dying from advanced heart failure. The aim was to develop a new approach and so overcome many of the previous referral barriers, improving patient quality-of-life, lessening time spent in hospital away from loved ones, reducing in-hospital deaths and helping many more patients to die at home.

This model of care emerged organically by fully and constantly engaging with service users. By co-producing this model of care together with patients and re-empowering them in their healthcare, the aim was to improve patient-reported experience whilst simultaneously showing value-based outcomes.

From 2016–2020, 236 heart failure patients were referred to the Supportive Care service, with 85% of service users reporting they would recommend the service to someone else in the same position as themselves. Introduction of the service resulted in a statistically significant reduction in heart failure-related admissions. This model of care also enabled more advanced heart failure patients to die at home, almost tripling the proportion of home deaths and reducing hospital deaths by up to one-third when comparing 2016 to 2016-2020 overall, with inpatient deaths approximately 50% lower than usual anticipated rates.

Clea Atkinson

clea.atkinson2@wales.nhs.uk