Connected Heart Care Pathway
Connected Heart Care Pathway is a new and innovative service spanning Camden and Haringey
It aims to achieve an end-to-end integrated pathway for managing heart failure, across primary and secondary care, as well as community services.
Vision and goals
- Reduce the prevalence gap when It comes to Heart Failure.
- Train and educate clinical staff on Heart Failure.
- Support and test a use case for remote monitoring.
- Help patients manage their condition remotely, all the while increasing their self-confidence in managing their own condition.
- We are also exploring the use of an EKO stethoscope, which uses AI to help clinicians diagnose patients with heart failure.
- Focusing initially on the West of Haringey, HTAAF aims to create a new BAU when it comes to managing heart failure.
Which agencies are involved?
- Haringey GP Federation
- North West PCN (Haringey)
- South West PCN (Haringey)
- North Camden PCN
- Whittington Health NHS Trust
- Royal Free London NHS Foundation Trust
When will the service launch and where will it be?
Based In North West and South West PCNs In Haringey and North Camden PCN In Camden.
The service launched at the end of July 2024.
How will the service work?
The service focuses on three patient groups:
- Priority Group A: Patients living with risk factors and suspected heart failure.
- These patients will go through a process of screening and diagnosis to reduce the prevalence gap.
- Priority Group B: Patients living with heart failure who need their annual review.
- These patients will be invited in for their usual check-and-test appointment (known as a ‘megaclinic’ in Camden) with a particular focus on heart failure tests to ensure they are still managing their condition well.
- Priority Group C: Patients living with heart failure who may be eligible for remote monitoring.
- These patients will be referred by secondary care into our integrated MDT, where eligibility for remote monitoring will be confirmed.
- At this point, the patient will be referred onto our remote monitoring platform Ortus iHealth where they will go through a process of rapid up-titration, supported by our dedicated clinical team and Digital Care Coordinator.
Contact details and team members
Marian Orafu, Senior Service Manager - marian.orafu@nhs.net | Service manager - To be confirmed
Materials and resources
These will be made available on the page in due course. We will want to use documents from Pumping Marvellous Foundation but don’t have these to hand in an online version right now.
What is the referral process?
We are a proactive service so not presently accepting referrals.
FAQs
Will the service be expanding Into the East of the borough?
There is a commitment to improve the whole heart failure pathway by setting out clear clinical and operational pathways to make scaling pan NCL easier. Funding is not guaranteed for this, but if we can demonstrate implementation and good outcomes, we may be able to attract more investment.
Does the service align with the LTC LCS?
Yes. There is a template specific to this service, but it includes codes that are also in the LTC LCS template, and thus our clinics will support practices and PCNs in meeting LCS targets.
How are patients remotely monitored?
We use a clinical software called Ortus iHealth.