Advanced Practitioner Cardiology Follow-up Clinic - A Cardiac Rehabilitation Led Service

Purpose

For the last 10 years, patients in North East Wales who had suffered a cardiac event and/or intervention such as PCI or CABG were followed up in cardiology clinics by Chest Pain Assessment nurses rather than Cardiologists. Cardiac Rehabilitation (CR) is provided as a separate service. Following the introduction of ACPs (3 nurses, 1 Physiotherapist) in CR, it has been observed that patient assessment and treatment is being duplicated between the 2 services. With the aim of streamlining services and avoiding this duplication, we took the decision to merge the services and absorb post intervention clinic into the CR service. It is hoped that the integration of the 2 services will lead to a more cost and time efficient journey for cardiac patients through the utilisation of advanced practice knowledge and skills.

Approach

We compared the 2 services. Follow-up after a cardiac event requires: 1. Clinical history taking and review of current cardiac symptoms 2. Clinical assessment (Blood pressure, heart rate and rhythm and chest auscultation) 3. Diagnostics to include blood tests (lipids, kidney function, liver function and glucose levels), ECG, echocardiogram, and cardiac stress tests 4. Cardioprotective medicine management (commencement and titration of medicines such as ACE-Inhibitors, Beta-blockers and anti-anginal medication)

Outcomes

Results: Following the addition of ACPs to the CR team, these requirements are increasingly met throughout the duration of a patient's Cardiac Rehabilitation journey, before the patient reaches the follow up cardiology clinic. We identified the need to formalise the ACP's assessment during CR to safely eradicate the requirement for standalone cardiology follow up clinic. It would be necessary for all patients to be seen at some point during their Cardiac Rehabilitation.

Conclusion(s): North East Wales Cardiac Rehabilitation service follows BACPR's guidance for best practice (British Association for Cardiac Prevention and Rehabilitation Standards and Core Components, 2017) when structuring their programme's. With the addition of advanced skills, all of the follow up clinic requirements could be met whilst also adhering to the BACPR's Standards and Core Components.

Cost and savings

It has not cost anything but projected saving of approx £6700 per annum for our team, and additional savings for other areas in the UK if they invest in more ACPs in Cardiac Rehabilitation to do clinics now run by Cardiologists.

Implications

All patients will be seen by an ACP during their rehab - an ACP will run a regular follow up CR clinic. A letter will be dictated at this clinic and admin will order casenotes and transcribe the letters. For patients who have undergone cardiac interventions or suffered an MI and do not attend CR (very few), they will be invited to a standalone clinic which will run only once every 6-8 weeks depending on need. The potential impact is a cost saving of approximately £6800 per year (5 hours per week of ACP (band 7 or 8a) time absorbed into existing CR service). There is also a time saving for patients and reduced impact on the CR service, as staff will be available for general CR input where they would previously have covered time taken for standalone follow up clinic. It will strengthen the case for an increase in ACPs within CR in other areas in UK- potential cost saving if existing services have follow up with consultants - £105,000.00 per year.

Top three learning points

No further data 

Funding acknowledgements

Not funded