Monitoring chronic heart failure in primary care

AIM:

This study aims to gather evidence to help develop more effective ways to monitor patients with chronic heart failure in UK primary care. In particular, the study will explore the effectiveness and associated costs of two monitoring tools - regular weight checks and the B-type natriuretic peptide (BNP) blood test. 

Why this is important:

This research will provide new evidence to inform the adequate management of chronic heart failure in UK primary care, and could mean that patients will have better, more effective ways of managing their condition

We are living longer and healthier lives due to health promotion, better medical care and improved disease prevention. However, this means that as many of us age, we may live longer with a chronic condition, such as diabetes, kidney disease, or coronary heart disease. How long-term conditions such as these are monitored is a major factor in their effective management. A 2002 report suggested around 900,000 people in the UK had chronic heart failure. More recently from the 2009-10 general practice (GP) return, over 600,000 prevalent cases have been reported in England alone. For those with chronic heart failure, the outlook is poor, so the majority of monitoring is conducted in the latter stages of disease. However, successful treatment of heart failure can improve patient quality-of-life, both in terms of physical and emotional well-being.

Currently in primary care, monitoring of heart failure is largely based on symptoms, but these tend to only appear late in the progression of illness and in acute cases. Recent trials of both BNP blood test guided monitoring and weight monitoring may be applicable and adaptable to primary care settings, but are likely to need modification for the less severe spectrum of heart failure.

Methods:

Firstly, we will determine the potential effectiveness and feasibility of using BNP-guided treatment and weight checks as a way of monitoring chronic heart failure in primary care. We will evaluate existing trials using BNP-guided treatment to see which components for these interventions are effective for the management of chronic heart failure.  The current evidence base will further be examined by completing three systematic reviews:

• evaluate the use of a home-based monitoring regime that incorporates daily body weight checks as part of chronic heart failure management;
• identify previous costs and cost-effectiveness studies of monitoring patients with chronic heart failure.
• evaluate the diagnostic accuracy of point-of-care BNP tests in chronic heart failure patients compared with laboratory readings.

The variability of BNP and weight will also be estimated using the Clinical Practice Research Datalink (CPRD) and data from our pilot study outlined below.

Pilot study:

Our pilot study will determine the feasibility of using point-of-care BNP blood tests for monitoring chronic heart failure in a primary care setting and to establish the willingness to participate in long-term cohort studies of BNP. 20-30 patients diagnosed with chronic heart failure in the previous 12 months will be invited to participate and patients will be followed for one year during which time relevant clinical data will be periodically obtained including BNP and quality-of-life data.

Finally, the human and practical aspects of all of the above research will be explored in focus groups and interviews with patients and health professionals.  Economic data will also be generated to estimate the associated costs behind each monitoring strategy.

The research team will be supported by a stakeholder group consisting of patients, public and health professionals.

How this could benefit patients:

This research will provide new evidence to inform the adequate management of chronic heart failure in UK primary care, and could mean that patients will have better, more effective ways of managing their condition.

It will advise on the suitability and appropriateness for routine use in UK primary care of point-of-care BNP guided treatment for chronic heart failure monitoring.  We will work with the National Institute for Health and Care Excellence (NICE) and GP commissioners across Oxfordshire to disseminate these findings.