The website of the Clinical Services Journal

Palliative at-home treatment for heart failure patients

A new approach to delivering palliative at-home treatment to advanced heart failure patients in Wales has been hailed a success – with hopes the award-winning model can be rolled out nationally.

For six years a dedicated team at University Hospital of Wales has championed offering infusions at home for suitable heart failure patients who are at end of life, thanks to support from district nurses who manage daily treatments via 24 hour syringe drivers. 

This model was used in about 10-15% of cases, and while it achieved its aims - to give patients their preferred place of care and place of death and reduce hospital admissions - the solution was costly and resource-intensive, until now.

A 12-month pilot, using an Accufuser elastomeric pump from leading medical device company Vygon, has allowed for continuous seven-day infusion to replace a daily routine. 

The portable elastomeric infusion pump is specifically designed for the simple, safe and accurate delivery of continuous flow infusions over a sustained period. It was used to give patients pre-prepared furosemide, in a formulation with a shelf life across the seven-days required, after being thoroughly assessed and produced by the hospital pharmacy. 

With 12 patients in Wales trialling the model over the past year, the hospital has calculated financial savings of over £1,500 and a reduction of district nurse time by 104 hours, per patient. The trial also positively impacted the carbon footprint of the community nursing team, due to fewer trips to and from patients’ homes.

Dr Clea Atkinson is Consultant in Supportive and Palliative Care at University Hospital of Wales, Cardiff and led the project. She explains: “While our existing approach had proven valuable in managing patients in the community in the last year of life, it also carried associated costs and human resource implications.

“This project offered a positive patient experience by allowing for care and the option to die where they wished – and for most this was at home. But we also succeeded in reducing adverse events and lessening the burden on hospital admissions, making the care more cost-effective, while improving the environmental impact. 

“We are now undertaking research among district nurses to gain their valuable feedback to inform our next steps, and we hope, if we can batch produce the seven-day stable formulation, we can scale this model up to be rolled out across the country for advanced heart failure patients, including those in rural areas of Wales.”

In the 12 months since the service was established, 12 patients received this new treatment method. Preliminary data shows that patients benefited from (mean average) 3kg fluid loss, a reduction in fluid swelling in the arms and legs (peripheral oedema level of at least 1 point) plus improvement in reported pain intensity and breathlessness (a visual-analogue-scale score of 2).

Vygon product specialist Iona Mackenzie adds: “The results of this pilot are really encouraging, considering it means patients who are in end stage heart failure, to have their pump changed weekly rather than daily, allowing them to maintain some semblance of a normal life.

“The benefit of the Accufuser is that it is simple enough to be used by the patient or carer. Palliative care of this nature can last for months, maybe even a few years, so it’s important that the pump is comfortable to wear, easily portable and discreet.”

The Accufuser elastomeric pump from Vygon is available in four sizes, 60ml, 100ml, 300ml and 600ml and flow rates can be adjusted from 0.5ml per hour, up to 250ml per hour. In addition to diuretics treatment, the device can be used for antibiotic infusions, pain management and chemotherapy.

The collaboration between University Hospital of Wales’ Supportive Care Service (SCS) and Vygon was honoured at the seventeenth annual MediWales Innovation Awards, which was held on 8 December 2022 in Cardiff. 

Celebrating the achievements of the life science sector in Wales, the awards recognised the project in the category of ‘Health and Social Care Research Partnership Award with Industry’.

Upcoming Events

The Third Annual Healthcare Innovation and Technology Conference and Exhibition 2024

Royal Society of Medicine, London
27th February 2024

Advancing Ultrasound Probe Decontamination Study Day

Horizon Leeds, 2 Kendall Street #3rd Floor Leeds LS10 1JR
12th March 2024

Webinar: How to be Compliant and Sustainable In Healthcare

ONLINE
19th March 2024 & 21st March 2024 10 am CET time o

POCT Innovators: The Power to Disrupt Series

Cloth Hall Court, Leeds. UK
20 March, 2024

Central Sterilising Club - Annual Scientific Meeting 2024

Crowne Plaza at Gerrard’s Cross
15th April 2024 – 16th April 2024

DECON UK 2024

National Conference Centre, Birmingham
17th April 2024

Access the latest issue of Clinical Services Journal on your mobile device together with an archive of back issues.

Download the FREE Clinical Services Journal app from your device's App store

Upcoming Events

The Third Annual Healthcare Innovation and Technology Conference and Exhibition 2024

Royal Society of Medicine, London
27th February 2024

Advancing Ultrasound Probe Decontamination Study Day

Horizon Leeds, 2 Kendall Street #3rd Floor Leeds LS10 1JR
12th March 2024

Webinar: How to be Compliant and Sustainable In Healthcare

ONLINE
19th March 2024 & 21st March 2024 10 am CET time o

POCT Innovators: The Power to Disrupt Series

Cloth Hall Court, Leeds. UK
20 March, 2024

Central Sterilising Club - Annual Scientific Meeting 2024

Crowne Plaza at Gerrard’s Cross
15th April 2024 – 16th April 2024

DECON UK 2024

National Conference Centre, Birmingham
17th April 2024

Access the latest issue of Clinical Services Journal on your mobile device together with an archive of back issues.

Download the FREE Clinical Services Journal app from your device's App store

Step Communications Ltd, Step House, North Farm Road, Tunbridge Wells, Kent TN2 3DR
Tel: 01892 779999
www.step-communications.com
© 2024 Step Communications Ltd. Registered in England. Registration Number 3893025