New Donegal Integrated Heart Failure Service Established

To coincide with European Heart Failure Awareness Week (10 to 16 May), Letterkenny University Hospital and Community Healthcare Organisation Area 1 (CHO1) has established a new Heart Failure Service which aims to support the diagnosis and treatment of people with heart failure living in Donegal.

Heart failure is one of the major chronic diseases in Ireland and quality of life can be improved with appropriate medication and lifestyle changes. It affects around 2% of the general population but this rises to 10% to those over 70 and is the leading cause of admission to hospital in those aged over 65. It is one of the major chronic diseases in Ireland and quality of life can be improved with appropriate medication and lifestyle changes.

The new Donegal Heart Failure Service has developed as an integrated team to support earlier access to diagnosis and treatment through the provision of a cardiac physiologist to perform echocardiography in community settings along with a clinical nurse specialist, an advanced nurse practitioner and clerical support to support primary care and hospital teams. Funding for the new service and a portable echocardiography machine was secured as part of Sláintecare Integration Funding.

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 arrival of COVID-19 led to some delays in progressing the new service. In December 2020 nursing staff were appointed and a cardiac physiologist was appointed in February this year. Also in February, dedicated heart failure clinics were established in three community locations: the Community Assessment Hub, Letterkenny; and in both Community Hospitals in Dungloe, and Carndonagh. A further site is due to commence in mid-May in Donegal Community Hospital. These clinics build on the services provided by the established Heart Failure Clinic at Letterkenny University Hospital (LUH).

The new service allows GPs to directly refer patients they suspect of having heart failure to the community service where they can get their echocardiogram and full assessment to confirm or rule out the diagnosis, which will then guide the treatment plan. It also allows patients who have been admitted to LUH with heart failure to have their follow up in community locations reducing the need to travel to Letterkenny for many.

Speaking of the new service Cathy Farrell, Advanced Nurse Practitioner said, “I have worked in LUH as a heart failure nurse for 15 years now and the number of people attending the clinic has more than doubled in that time. I am delighted to see this new service which will allow earlier diagnosis and therefore treatment of heart failure. We know through appropriate education of self-management and self-monitoring we can improve quality of life and reduce hospitalisations and this service will allow us to see more people in a more timely manner.”

Seán Murphy, Hospital Manager, Letterkenny University Hospital said, "Letterkenny University Hospital and our cardiology service in particular are delighted to be part of this innovative service development for patients with heart failure.  As Cathy highlighted, cardiac illness is unfortunately increasing in Donegal. This Sláintecare project delivers a service to those patients with heart failure across the County, integrated with the acute hospital based service.  This approach which provides easier access for patients will also be the future for other services and I congratulate all those who have been involved in realising this vision for the care of patients with heart failure.”

Ciaran O’Fearraigh, GP in Millbrae Surgery Stranorlar added, “It’s great to see investment in community services and better access to diagnostics in primary care. The existing heart failure service in LUH has been a great support to those with heart failure in Donegal and to General Practice. This new service builds on that, with timely access to high quality diagnostics and care in the community setting, and will hopefully provide a model for further projects going forward.”

Mandy Doyle, Primary Care General Manager for CHO1 said, “Donegal Integrated Service for Heart failure demonstrates the potential and further possibilities of what can be achieved through the Sláintecare principles of ‘right care, right place, right time’ and the integration of primary and secondary care.  The Sláintecare vision for healthcare is one where care is seamless and integrated and is provided at the most appropriate service level. This new integrated heart failure service is a fine example of this, a service that seeks to improve the quality of care for individual patients by ensuring that services are well co-ordinated around their needs. This collaboration between Primary Care Donegal and LUH enables primary and secondary care to be aligned in one system closer to the local community. This also supports a more efficient and coordinated transfer of care and improved experience for people accessing our services. Keeping the patient central is most important for all of the healthcare workers involved.”