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Improving care pathways

Improving care pathways – examples from cardiovascular disease

We work in partnership with commercial clients, patient and ԰AV organisations to strengthen pathways throughout the patient healthcare journey. Here is an example of work we’ve done with one of our commercial clients in cardiology to improve the detection, management and treatment of patients with heart valve disease.

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Why optimise the heart valve disease pathway?

Cardiovascular disease (CVD) is group of interrelated conditions which are responsible for a quarter of all deaths in the UK.1

Among these deadly conditions is heart valve disease (HVD).

If diagnosed early, HVD can be treated effectively with heart valve replacement or repair before a patient’s condition deteriorates. Unfortunately HVD is notoriously underdiagnosed, frequently going unnoticed or mistaken for ageing by patients and clinicians. For many patients, the condition is identified simply too late to benefit from treatment. Inadequate detection, late treatment or no treatment, often results in a devastating outlook for patients.

Five-year survival rates for some forms of severe HVD, such as severe symptomatic aortic stenosis (AS), are poorer than many common metastatic cancers in the UK,2 and about 50% of people with the condition who do not receive effective or appropriate treatment do not survive two years.2

The ԰AV faces a number of challenges with HVD:

  • Poor recognition among healthcare professionals
    Common symptoms, like breathlessness and reduced exercise tolerance, may be attributed to advancing age.
  • Reduced opportunities for chest auscultation
    The first step to HVD diagnosis is identification of a heart murmur. This requires chest auscultation; however, reduction in face-to-face appointments during the COVID-19 pandemic and increased overall pressure on GP services limits opportunities for HVD detection.
  • Strain on echocardiography
    Patients with a heart murmur are referred to echocardiography for diagnosis. However, echocardiography service capacity is under enormous strain. The ԰AV is struggling to retain, recruit and train staff, leading to increased pressures on the existing workforce and significant backlogs.
  • Long waits for life-saving treatment
    Increased capacity is needed in specialist heart centres to ensure treatment can be delivered on time. Patients often face long waiting times to access the treatment they need. All the while, the condition deteriorates and the chance of a good outcome fades.

References

  1. British Heart Foundation. Facts and figures. 2022. Available at: (accessed March 2023).
  2. Ali N, Faour A, Rawlins J, et al. ‘Valve for Life’: tackling the deficit in transcatheter treatment of heart valve disease in the UK. Open Heart 2021;8:e001547.

Our portfolio of work

԰AV has been working on optimising ԰AV patient pathways in CVD, which includes HVD, to enhance proactive detection and decrease waiting times for treatment, so that patients can receive prompt, often lifesaving, treatment. Here are some examples of our work

Break Free From CVD

It’s time to rethink cardiovascular disease and react accordingly. Created by an expert group of clinicians and stakeholders, the Break free from CVD toolkit helps us refine our understanding of CVD and sets out ready-to-action solutions for systems to implement in community settings.

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Patient scenario: Malcolm’s story of aortic valve disease

Developed by a group of experts, Malcolm’s story sets out two distinct care pathways for patients with severe symptomatic AS. A suboptimal, or ‘average’ pathway, illustrates the potentially devastating consequences of maintaining the status quo. In contrast, the optimal pathway showcases the opportunities for improvement, both from a patient outcome and economic perspective.

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Community care pathway for the detection and management of HVD

This interactive PDF maps out an exemplar community pathway for the detection and management of HVD.

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Background and process: developing a community pathway for HVD

This report describes how and why the community pathway for HVD was developed.

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Pilot project: community pharmacy detection of HVD in Farnborough

This pilot project in Farnborough Primary Care Network (PCN) describes HVD detection successfully in action in the community pharmacy setting.

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An Economic Model: Proactive detection of heart valve disease in community pharmacy

Based on an evaluation of the Farnborough PCN Pilot project, this tool aims to help ICBs understand the financial implications and influence of establishing a proactive detection service for HVD in community pharmacy.

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Patient scenario: Cecile’s story of degenerative mitral regurgitation

Developed by a group of experts, Cecile’s story sets out two different patient journeys with degenerative mitral regurgitation. A suboptimal, or ‘average’ pathway, highlights where opportunities are typically missed, whereas the optimal pathway illustrates how care can be improved to deliver better patient outcomes and cost efficiencies.

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