Developing a pathway for individuals with heart failure with preserved ejection fraction (hfpef): scoping the population accessing unscheduled care
Authors: Cowie A , Mckeddie M , Mckay J , Cooke M 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Scottish Government

Background
The Heart Disease Action Plan’s vision that everyone in Scotland is supported to live well with their heart condition(s) [1]. In 2021 NHS Ayrshire and Arran (NHS A&A) was successful in attaining Scottish Government funding to develop and pilot a care pathway for those with heart failure with preserved ejection fraction (HFpEF). HFpEF is not widely understood by the wider healthcare community, and this population’s access to care is limited. To help inform development of this pathway, a scoping exercise was undertaken to fully understand the needs of the HFpEF population, and to provide baseline data for evaluation of the new pathway.

Purpose
As part of the scoping exercise, data were examined to help identify and describe the HFpEF population accruing unscheduled care admissions within NHS A&A. It was anticipated that these individuals would be most likely to benefit from the new pathway.

Methods
Data were obtained using these criteria:
- Unscheduled care admission from 1st July to 31st December 2021 (inclusive)
- Admissions with HFpEF listed as a primary or secondary cause of admission
Demographic, diagnostic, mortality and morbidity information of individuals accruing these admissions were examined to provide a clinical picture of the population.

Results
During the time period, 81 individuals were admitted to hospital with HFpEF.
The mean age of the population was 79.6yrs (31 males [38%] 50 [62%] female) and most (n=26; 32%) were living in areas classed as SIMD 3 [2].
Of the 81, all presented with left ventricular ejection fraction ≥50%, n=59 (73%) had biatrial dilatation, and n=26 (32%) had evidence of right ventricular impairment. Valve disease was present in n=53 (66%). High filling pressures were evident in up to n=39 (48%).
The population presented with an average of four co-existing morbidities. Most prevalent were hypertension (n=56; 69%), atrial fibrillation (n=46; 57%), diabetes (n=35; 43%) and chronic kidney disease (n=35; 43%).
A total of 160 admissions / 1171 bed days were accrued by the whole population during the time period. Of these admissions, 56 (35%) were ≥ 10 days, however 44 (29%) were 1-day admissions.
The primary cause of admission was HFpEF in 64 cases and HFpEF was listed as a secondary cause for a further 37 admissions. A further 24 admissions were due to cardiovascular disease (CVD).
To date, n=31 (38%) have died (n=20 during their last 2021 admission, n=11 thereafter). CVD was listed as the primary cause of death in n=11, and in n=7 this was specifically HFpEF.

Conclusions
These data show the HFpEF population accessing unscheduled care with NHSA&A to be elderly, and mainly female with multimorbidity. Both bed days accrued and mortality rate were high. The data have informed development and implementation of a new care pathway, and it is hoped that evaluation of the pathway will demonstrate a positive impact upon these data.