The Need

For Delivering Quality and Value

Both the prevalence and incidence of heart failure are rising and there is good evidence that appropriate diagnosis, treatment and ongoing support can improve the quality of life and help reduce morbidity and mortality.

The NHS Plan1 highlights the need to improve access to services with the redesigning of care pathways around the needs and convenience of the patient.

Chapter 6 (Standard 11) of the NSF on CHD2 focuses on the management of heart failure and requires that echocardiography be carried out on all patients with suspected heart failure.

Implementation of the NICE guideline for heart failure (Clinical Guideline 5)3 and the Quality and Outcomes Framework for GPs4 will further increase the demand for echocardiography services.

From the end of 2008, no one will wait longer than 18 weeks from GP referral to hospital treatment.5 The Heart Improvement Programme suggests a maximum wait time of 2 weeks for echocardiography in order to meet the 18 week referral to treatment target.7

Greater access to diagnostic tests in primary care could reduce unnecessary referrals. At present approximately 60% of people referred for specialist assessment are not subsequently diagnosed with heart failure.8

With the development of Integrated Care Organisations via Practice Based Commissioning, the opportunity to move echocardiography into the community now exists.

Furthermore, in the NHS Next Stage Review Final Report - High Quality Care for All6, all the visions emphasised the importance of rapid access to diagnostics in convenient locations.

Recent developments in technology now mean that high performance echocardiography can be achieved within primary care without compromising diagnostic accuracy for portability.

The introduction of Web based PACS UltraLinq.co.uk allows the real-time access to study images. 

'Commissioners should be aware that the diagnostic tests required [heart failure] can be provided in either primary or secondary care.'8

Delivery of high quality care (including the early and accurate diagnosis / treatment of heart failure and the better management of patients closer to home) reduces the overall cost burden for managing heart failure.

'Good quality care costs less than sub-optimal care - length of stay, admission rate and readmission rates are reduced.'8

Other bottom line savings include:

• Reduced inappropriate secondary care attendances
• Reduction in outpatients appointments
• Efficient and appropriate use of specialist teams

Bringing together all of these developments, Echotech is an innovative strategy allowing the provision of echocardiography in the primary care setting, thereby facilitating the 'local', early and accurate diagnosis of cardiac abnormalities.

By streamlining the diagnostic process Echotech allows the right patient to receive the appropriate treatment at the optimal time.

1. The NHS Plan: a plan for investment, a plan for reform. DH July 2000.
2. National Service Framework for Coronary Heart Disease. DH March 2000.
3. NICE Clinical Guideline 5. Chronic Heart Failure. July 2003.
4. Quality and Outcomes Framework. DH 2006.
5. The NHS Improvement Plan. DH June 2004.
6. NHS Next Stage Review Final Report. DH June 2008.
7. The Heart Improvement Programme.
8. NICE Commissioning Guide 2008. Focus on:Heart Failure. NHS Institute for Innovation and Improvement. Jan 2009.