A new report from the UK advocacy charity Heart Valve Voice suggests that prompt diagnosis of heart valve disease and faster access to treatments such as transcatheter aortic valve implantation (TAVI) could reduce healthcare system costs through fewer emergency admissions, shorter hospital stays and less need for escalation to social services if patients remain in good health.
Economic modelling released by the charity indicates potential savings per person of 51.7% (around £35,000) based on the current costs incurred by the National Health Service (NHS) to treat conditions such as aortic stenosis, meaning that for the same system cost currently associated with one patient following a ‘typical’ pathway, the NHS could potentially diagnose and treat two patients through an ‘ideal’ pathway.
“Our report, developed in collaboration with the British Heart Valve Society, Primary Care Cardiovascular Society, the British Society of Echocardiography and Valve for Life, shows that a better pathway design will not only save lives but deliver efficiencies that offset the cost of intervention,” explains Wil Woan, executive director of Heart Valve Voice. “Prompt diagnosis and faster access to treatment would mean the NHS can reduce avoidable admissions and complications, generating savings that offset the cost of interventions, like TAVI, and lower the overall financial burden. This report challenges the assumption that substantial new funding is required (in fact, the NHS can make savings by being more efficient) and this approach will save lives: hundreds of heart valve disease patients die while waiting for treatment.”
“We see the same patterns happening to UK patients again and again,” says Jonathan Byrne (King’s College Hospital, London, UK), UK Lead of the Valve for Life programme, an initiative that aims to improve and expand access to transcatheter therapies for heart valve disease. “People see their GP several times with breathlessness or dizziness, but valve disease isn’t suspected, so they move through months of tests and repeat appointments without getting the right diagnosis. As their condition worsens, they start turning up in A&E or even reach crisis point and come in by ambulance. Aortic stenosis can make patients so unwell so rapidly that social services have to step in because they can’t look after themselves or their partner. It places a huge burden across primary and secondary care, emergency services and even social care—but this new report shows clearly that this cascade could be avoided.”
Heart Valve Voice has offered the case study of the Rapid Access Valve Assessment (RAVA) clinic at Wythenshawe Hospital, part of Manchester University NHS Foundation Trust (Manchester, UK) as demonstrating the impact of an “ideal” patient pathway.
According to the charity, instead of patients circulating between multiple referrals and departments; sonographers conduct the initial echocardiogram refer individuals with severe aortic stenosis directly into the RAVA clinic. This removes unnecessary delays and administrative steps, ensuring patients are seen by clinicians with specialist expertise in valve disease who are more attuned than general cardiology teams to early signs of valve disease deterioration and able to intervene promptly when required, Heart Valve Voice claims.
Keith Pearce, programme clinical lead for RAVA and lead consultant cardiac scientist at Manchester University NHS Foundation Trust (Manchester, UK), said: “This specialised pathway has delivered remarkable results. The wait for valve treatment has fallen from 220 days to just 49 here. In some cases, we act even faster: one recent patient had severe valve disease identified on an echocardiogram and underwent a TAVI procedure within two weeks. This seamless community to specialist model is highly efficient and reduces pressure on wider cardiology, GP and emergency services. We have successfully rolled this out across five UK centres.”
