Consultant-led Virtual Heart Failure Clinics for GPs in East Galway

At the end of last year the Heart Failure Service developed by Portiuncula University Hospital and Galway Primary Care introduced virtual heart failure clinics for GPs in East Galway to discuss treatment plans and improve patient care. Once a week up to six GPs can discuss individual patient symptoms and treatment with the Heart Failure Team, on a one to one basis, via video conference. It promotes a more holistic approach to patient care and supports GPs to keep their patients well and out of hospital.

In line with Sláintecare’s objectives, the service aims to deliver more integrated care, supporting care nearer the home, helping to reduce and prevent hospital visits and supporting the ultimate goal of reducing waiting lists and reducing waiting times.

The service is led by Dr Aidan Flynn, Consultant Cardiologist at Portiuncula University Hospital who said, “Over the past year we have expanded our heart failure service to provide additional services to patients in their local primary care centres. This is building on the integrated community heart failure programme with our colleagues in Galway Primary Care which has been underway since 2009. In 2019 we successfully received funding as part of the Sláintecare Integration Fund to enhance this community-based service.

“We now provide two types of cardiac investigations from three Primary Care Centres in County Galway and one in County Roscommon: an echocardiogram which is an ultrasound test to assess the structure and function of the heart muscles and valves; and holter monitoring which is 24 hour continuous recording of the heart’s electrical rhythm to record any irregular heartbeat. Both of these tests are essential in helping to diagnose heart failure and to monitor patients’ progress with treatment. In the past these tests were only available in the hospital but now we can bring the services to the patient.

“The next phase of our expansion of the Heart Failure Service is to support GPs who are seeing more patients being diagnosed with heart failure and living with heart failure. Heart failure is a common life-limiting chronic illness and it is estimated that 90,000 people in Ireland suffer from the disease with 10,000 new cases been diagnosed each year. The increase is mainly due to an aging population, an increase in the number of patients surviving acute cardiac events and the rise in diseases such as hypertension and diabetes. In December we held our first virtual heart failure clinic and since then we have been running one or two clinics per week depending on demand.”

The goal of Sláintecare is that health and social care services will be built around the need of the people, such that most illnesses and minor injuries can be treated in the community. People will be able to stay healthy in their homes and communities, only attending hospital when necessary. This will result in shorter hospital waiting times for those who need to attend hospital.

Catherine Nolan, candidate Advanced Nurse Practitioner takes part in the virtual heart failure clinics with the GPs and provides a specialist nurse clinic for patients with heart failure in the primary care centres. She said, “We are developing our service to put patients at the centre of what we do and make sure that we get the right care to the right patients at the right time. GPs can now email us to book a time slot for the virtual clinic and based on the outcome of the discussion with Dr Flynn and myself, we can follow up and arrange for blood tests or a cardiac investigation such as echocardiogram or holter monitoring for the patient, as required.

“I can also arrange to meet the patient in their nearest primary care centre on the day that they are scheduled for their echocardiogram or holter monitoring to carry out the blood tests and to provide patient and carer education on self-managing the disease. This empowers patients to more actively manage their condition. I also liaise directly with the GPs with the results of their patients’ tests and can link back with Dr Flynn if there is need for further investigations.”

Siobhan Woods, Primary Care Development Officer for Galway and Roscommon added, “The feedback from the GPs who have used this service has been very positive. A year ago the idea of a videoconferencing with our GP colleagues would have unusual but now we all appreciate the efficiency of meeting virtually and the benefits for everyone involved. We are gradually moving away from the traditional model of all services being delivered from a hospital site and towards bringing the services to the patient which is more convenient, less stressful and easier for our patients to manage a long term chronic illness such as heart failure.”

Minister for Health, Stephen Donnelly TD said, “I would like to acknowledge and welcome the work being done by this innovative Sláintecare funded project. The introduction of the Virtual Heart Failure Clinics for GPs in East Galway demonstrates how a joint approach between staff based in hospital, primary care and the community can work together to improve access for patients. Patients with heart failure symptoms now have timely access to specialist heart failure nursing services and rapid access to consultant cardiologist expert opinion through the Heart Failure Virtual Clinic and in a service close to their home.”