“There are inequalities in access to cardiac interventions that are performed in specialised units. An example of these are complex implantable electronic devices (CIED); treatments that have been proven to save lives and improve quality of life in selected patients. There are well established national and international guidelines defining which patients will benefit from CIED implantation and UK NICE-recommendations reflect these guidelines. Selected patients who would be most likely to benefit from this treatment frequently don’t receive it because they never get to meet a CIED specialist.
When we started developing the partnership between our unit and Inspira Health to establish the Primary Care Heart Failure Service, we wanted to bring cardiologists with sub-speciality expertise in CIEDs into the community and see appropriate patients as close as possible to their homes. The aim was to minimise the steps in the referral pathway, provide an immediate opinion to the target population and offer CIED implants to patients in the NHS according to NICE-criteria, who had been previously overlooked.
The team at Inspira Health have developed a highly efficient way of screening patients using GP records and triaging patients. Furthermore, across the UK they have developed new working relationships with individual GP practices, often in very deprived areas, by effectively describing the patient benefits and gained their agreement to participate in these novel screening audits. This has needed a good understanding and sensitivity to established local services and referral pathways. They have helped set up Consultant Cardiologist clinics in collaboration with the NHS to see targeted patients and ensured prompt referral into specialist units where patients meet NICE-criteria. There are a number of examples of patients treated in our NHS institution (who have received an CIED implant) who we know would have died, were it not for this Service.
At all times, I have been impressed at the high level of collaboration between different disciplines, good IT governance, confidentiality, and patient autonomy / choice. This Service has increased implantation rates in geographical areas with low CIED implantation rates, which are often in some of the most deprived areas of the country. I am certain this private-public collaboration provides a excellent model for other disciplines to reduce inequality of access to specialised proven interventions’”