35 The impact of Northern Ireland 1st advanced nurse practitioner led pilot initiative cardiac valve surveillance clinic on the review of moderate to severe aortic stenosis patients

Résumé fourni par la source

The Advanced Nurse Practitioner Led Cardiac Valve Surveillance Clinic initiative was undertaken in the Cardiology Department, Ulster Hospital. The first of its type in Northern Ireland. The project involved key stakeholders including Cardiology Consultants who provide clinical governance. The focus group were patients with moderate to severe aortic stenosis (AS). As our population ages cardiology services will need to change. Many more patients will be living longer and with the effected by valvular heart disease. With advances in our understanding of valve disease pathology, valve imaging and novel interventions we are able to do avoid unnecessary morbidity and mortality through early detection and timely intervention. Prior to the clinic initiative patient were assessed at the out-patient clinics however, this avenue resulted in lengthy delays and time windows for evaluation and treatments were suboptimal. Following on from the pandemic restrictions the clinic was developed in 2020 and came to fruition in 2021. This clinic provides a coordinated holistic care bundle that facilitates clinical evaluation, diagnostic testing, and timely clinical interventions for patients with Aortic Stenosis. The aim is to reduce patient waiting times, ensure compliance with ESC guidelines review times. In collaboration with the Cardiac Investigation Unit data was collected from a Data Management Software. From the data a registry of all patients was developed who had an echocardiogram performed for aortic stenosis assessment between December 2019 and December 2020. Only patients with moderate/severe aortic stenosis were appointed to the novel valve clinic. A cohort of 257 patients with aortic stenosis where identified. A subgroup of 42% (n=107) where classified as moderate AS, 16% (n=43) as severe AS. Review times were correlated with patient electronic care records. An audit of the data was completed and presented at the Working Group Meetings for the relevant stakeholders. These patients were removed from the routine cardiology out-patient lists and all were reviewed in the Cardiac Valve Surveillance Clinic. The clinic offers routine clinical review by an autonomous advanced practice clinician and echo assessment by specialists with extensive experience in the examination of native valves. Providing a more effective and efficient pathway thereby avoiding overpopulating lengthy out-patient lists. An audit of the new clinic was completed in 2022 which examined the same statistical data analysis used in the original audit - waiting times and adherence to review guidelines. All patients had no longer than a 15-week waiting time to be reviewed in clinic, comparative to a 122 weeks at the out-patient clinic. 100% of severe AS patients and 88% of moderate AS patients attending the Cardiac Valve Surveillance Clinic were reviewed within the 6 month or 1-year recommended guidelines (respectively). 59% of severe AS and 45% of moderate AS were reviewed with the recommended timeframes at the out-patient clinic. The service audit demonstrates a significant reduction in patient waiting times and marked improvement in compliance with current guidelines for review. Early detection of progression of valvular disease, improved early intervention, avoidance of unnecessary hospitalisation and costly cardiac compromise.

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