Home is where the best heart care is

30 April 2008

Joshua Rowe, chairman for telemedicine specialist Broomwell Healthwatch, explains how a cardiac telemedicine service can improve patient care whilst cutting the cost of congestive heart failure (CHF).

The cost of diagnosing, treating and caring for patients with cardiac related problems represents the single largest financial burden on the UK's National Health Service (NHS). The estimated cost of cardiac care annually in the UK is over £34 billion [1], with the cost to the taxpayer of treating cardiac A&E patients averaging at around £305,000 per patient [2].

One cardiac condition impacting greatly on the NHS is congestive heart failure (CHF). The total direct medical cost of this long-term condition in the UK each year is currently just over £625 million [3], with hospital inpatient care of CHF being the biggest single healthcare cost, accounting for approximately 60% of the total cost of CHF in the UK [4].

This issue needs to be addressed. Conventional methods of treatment aim to reduce symptoms and delay progression of the disease, reduce hospitalisation and extend and improve the patient's quality of life.

However the ideal would be to deploy a method that not only monitors and manages the symptoms of CHF but also significantly reduces its cost to the NHS. Adopting a solution which has the ability to move treatment away from hospital care to home care seems the best way to achieve this.

Home care cardiology

The average length of stay for a patient admitted to hospital with CHF is over 13 days, three times the average length of stay for all patients [5].

Detecting, diagnosing and treating cardiac symptoms at an earlier stage will help prevent avoidable hospital admissions, thereby cutting costs, freeing up resources in secondary care and allowing NHS resources to be reallocated to other key areas. Early detection means patients receive more timely and preventative support, therefore reducing the need for hospitalisation; this not only benefits patients from a clinical point of view, it also helps to alleviate the overall burden on the NHS.

The telemedical weight scalesBroomwell Healthwatch has developed a telemedical solution for monitoring and managing CHF from the patient’s own home. Our telemedical weight scales and blood pressure monitor both detect early symptoms associated with CHF, such as weight gain through fluid build-up and increased blood pressure [6], allowing physicians to monitor patients’ progress, diagnose problems quickly and administer timely preventative care, delaying progression of the disease and helping to save lives.

Typically CHF patients are expected to keep a diary of their weight and visit their GP on a regular basis for an evaluation, but this method relies heavily on the patient remembering to keep an up-to-date and coherent record of information.

The weight scales and blood pressure monitor solution relieves patients of this responsibility whilst giving monitoring clinicians a more reliable and accurate result. It also transfers the responsibility of detecting any significant changes from the GP to a cardiac clinician trained specifically in this area of medicine.

Ultimately the clinical responsibility does rest with the patient’s GP but this solution allows patients to have their weight and blood pressure carefully monitored from the comfort and convenience of their own home, meaning they avoid constant trips to the GP for routine evaluations and unnecessary trips to hospital. This reduces stress for the patient and reduces the operational and financial burden on the NHS.

Telemedicine explained

The scales measure the patient’s weight and transmit the data automatically to Broomwell’s monitoring centre via a home gateway unit. Blood pressure readings are transmitted in a similar way. Cardiac clinicians at the centre monitor the data for any potentially dangerous trends or deviations from the set parameters, meaning prompt action can be taken if needed.

On receipt of the data, clinicians at the monitoring centre are automatically presented with the patient’s clinical records and medical history. If any abnormalities are identified, the results are transmitted to district nurses and / or the patient’s physician for early intervention, or in more critical cases the patient is sent for emergency treatment.

The obviously ill patients are easier to manage; these patients receive prompt intervention, stabilisation and rapid referral to the appropriate facility. The challenge begins with those patients who show subtle signs and symptoms of a cardiovascular condition or CHF; this is where the expert service is of most benefit.

Weighing up the benefits

Giving GPs access to fast expert advice on sometimes complex cardiac issues is an invaluable aid and Broomwell’s studies suggest that home monitoring of patients with CHF can save the NHS over £60 million each year and save thousands of lives.

Our research shows that CHF-related hospital admissions account for 62,582 episodes per year, costing the NHS around £211 million annually. By saving the NHS over £60 million a year, the CHF monitoring solutions could free up 29% of the overall cost spent on CHF by the NHS per annum.

The service is great for both patients and the NHS. As well as delivering financial benefits it will have a considerable impact on diagnostic efficiency — contributing to achieving a higher level of patient care.

Cardiac telemedicine helps fast and accurate diagnoses to be made, reassuring the majority of patients within their own homes that their condition is stable, thus preventing unnecessary GP visits, whilst those in immediate danger are transferred to hospital care.

A £60 million a year saving means the NHS could re-allocate funds to other key areas and monitoring CHF at home would lessen the operational burden on GPs and hospitals, freeing-up resources. The service has the potential to make a huge difference to the NHS whilst saving the lives of thousands of patients.

The technology has already been rolled out across a major city primary care trust to help monitor and diagnose CHF and has had positive results.

Cardiac telemedicine has brought the expertise of leading cardiologists straight into the homes of CHF patients. This proactive, preventative approach not only provides a more effective model of care for cardiac patients, but also helps ensure NHS resources are optimised and used as effectively as possible.

Joshua Rowe, Chairman of Broomwell Healthwatch.


1. British Heart Foundation Statistics Database, 2006, www.heartstats.org www.heartstats.org/datapage.asp?id=101 

2. Dr Foster Intelligence www.drfoster.co.uk

3. British Heart Foundation Statistics Database, 2006 www.heartstats.org/datapage.asp?id=817

4. British Heart Foundation Statistics Database, 2006 www.heartstats.org/datapage.asp?id=817

5. British Heart Foundation Statistics Database, 2006 www.heartstats.org/topic.asp?id=858

6. NHS Direct website: www.nhsdirect.nhs.uk/articles/article.aspx?
  & www.nhsdirect.nhs.uk/articles/article.aspx?articleId=189&sectionId=5


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