Service evaluation of an advanced clinical practitioner (ACP) led one-stop combined cardiology and echocardiography outpatient clinic
Authors: Spencer C , Beadle R 
Published: January 2025

Abstract

Introduction
Traditional models of hospital-based outpatient care are inefficient, unsustainable and fail to meet patient’s needs and preferences (RCP 2018). We developed a novel one-stop clinic including echocardiography delivered by a British Society of Echocardiography (BSE) accredited ACP at a district general hospital in the west Midlands, UK. No clinics of this type were identified in the literature, although there are studies demonstrating the efficacy of physiologist led valve clinics (Wasing et al., 2009) and cardiologist led ‘one stop’ clinics (Falces et al., 2008).

Purpose
To evaluate the outcomes for the first 12 months of the ‘scan and treat’ clinic.

Methods
Patient demographics, reason for referral and clinic actions were collected prospectively between July 2022 and June 2023. A retrospective electronic chart review of outcomes was completed on 1/2/2024. An un-blinded cardiologist also reviewed the records and echo images of all deaths and a further 20 randomly selected cases in February 2024.

Results
143 patients were seen over 22 clinics. The most common reason for referral was suspected heart failure (34%) (table 1). Heart Failure (HFrEF, HFmrEF, HFpEF) was also the most common primary diagnosis (31%) although almost half (47%) had other reasons for referral. The reviewing Cardiologist reported appropriate diagnosis and treatment plans in the reviewed cases including all 7 deaths (5%) (3 heart failure related, 4 non-cardiac). Outcomes (figure 1) included 29 procedures: 10 DC cardioversions, 1 PCI (following the planned angiogram), 9 pacemakers (including 4 CRT devices), 3 TAVI and 6 Ablation procedures. There were 11 hospital admissions for potential cardiac causes; 1 decompensated HFrEF that may have been prevented with earlier follow up, 2 syncope cases (1 HFrEF with hypotension, 1 potential dysrrhythmia). The remaining 8 were chest pain discharged without intervention. The 17 patients (12%) with treatment changes at consultant follow up included: 1 pacemaker for asymptomatic 2nd degree AV block, 1 angiogram to investigate HFrEF and 1 sleep study for HFpEF. A further 7 had medication side effects, 4 following test results and 3 with new symptoms. 1 diagnosis of angina was overturned following a normal coronary angiogram.

Conclusion
This service evaluation suggests the ‘scan and treat’ clinic is a viable alternative to a traditional general cardiology clinic when an echocardiogram is also requested at triage. This has reduced total hospital visits for selected patients, streamlined care and provided additional clinic capacity with no signal of adverse outcomes. This kind of initiative may help reduce face to face appointments in line with the ‘getting it right fist time’ (GIRFT) recommendations (NHS, 2021). This review has a number of limitations including a single centre and clinician design. Further research is required to assess the safety and efficacy of this and similar non-cardiologist led ‘one-stop’ clinic designs.
Table 1
Figure 1