Transforming care for people with heart failure through virtual wards

Virtual wards are transforming how we care for people who are unwell due to heart failure.

Professor Nick Linker, National Clinical Director for Heart Disease, NHS England, and Dr Rajiv Sankaranarayanan, Consultant Cardiologist and Heart Failure Virtual Ward Lead, Cheshire and Merseyside ICB, reflect on how this innovative approach is bringing care and treatment into people’s homes, its potential – and why it’s better for patients and their families.

Living with heart failure is becoming more common. It’s estimated over 900,000 people live with heart failure, with around 200,000 new diagnoses made annually in the UK. We see high rates of hospital admission and readmission for those with the condition. Heart failure patients account for 2% of the total NHS budget and for 5% of all emergency hospital admissions in the UK.

Virtual wards, also known as hospital at home, offer us an opportunity to care for suitable people in the familiar and comforting environment of their own home, including care homes, as an alternative to being in hospital. Increasingly, virtual ward teams are supporting people who would have been admitted into hospital with heart failure.

Rajiv’s team at the Liverpool University Hospitals NHS Foundation Trust (LUHFT), along with partners Mersey Care NHS Foundation Trust who provide the telehealth service have supported more than 500 people in this way since May 2022. He explains: “our experience of treating suitable patients with heart failure decompensation at home instead of in hospital and allowing them to be treated by our heart failure specialist teams in the community with the aid of telehealth technology, has shown that it helps with their recovery and improves their outcomes”.

“For example, one of our first patients, Colette, had fluid overload due to damage to her heart muscle. She also has Crohn’s disease, causing frequent flare-ups and making it more difficult to treat her acute heart failure”. The heart failure virtual ward team treated her with outpatient intravenous diuretics, which relieved her fluid overload, and gave her medication to make her heart pump stronger, all whilst being managed on the acute heart failure virtual ward.

Mersey Care’s telehealth team reviewed Colette every day and the ‘ward round’ took place over telephone or video call. Tech devices provided a daily ECG, measured her vitals like blood pressure, blood oxygen levels and pulse, and she could record symptoms and observations, with readings sent to the team.

Being cared for by the virtual ward made Colette “feel really reassured” and reduced her hospital visits. “If there is anything the nurses are concerned about from my data, they can contact the on-call consultant cardiologist – perhaps they will advise that I reduce or increase medication” she said. “It’s almost like having a doctor on tap. It’s a really personalised service”.

As Colette has experienced, people with heart failure often have other conditions too, which may mean they spend more time in hospital overall. Being cared for by a virtual ward enables them to be treated at home – as Colette said, “it gives you your life back”.

Given these overwhelming benefits for patients, we urge all cardiology teams to read and action the new guidance published by NHS England on caring for people with heart failure on virtual wards.

The guidance is invaluable for teams looking to set up dedicated ‘heart failure’ virtual wards. It can also support other clinical teams who are considering adding heart failure care as part of their existing virtual ward(s), for example for frailty, who are keen to include specialist input from cardiologists.

The guidance has been developed with people living with heart failure, national representative bodies, those delivering frontline heart failure care, as well as those working at a system and national level, such as the Cardiac Delivery Board, the British Society for Heart Failure and the Pumping Marvellous Foundation.

If you’re looking at this area, read the guidance, join the virtual wards FutureNHS to engage with others already in this field, and watch the community of practice webinar.

This is a significant step in the efforts of the NHS to deliver more care closer to people’s homes. We look forward to seeing more people benefit from approaches like this in the coming years.

Professor Nick Linker

Professor Nick Linker was the National Clinical Director for Heart Disease for NHS England (2019-2024). He led on the implementation of the NHS Long Term Plan for heart disease, the development of heart disease policy for Specialised Commissioning, and was Chair of the Cardiac Services Clinical Reference Group. He was Clinical lead for the Cardiac Transformation Programme and has responsibility for the national cardiac registries.

He trained in Manchester Royal Infirmary and St George’s Hospital, London and was appointed as a consultant cardiologist with an interest in cardiac electrophysiology at South Tees Hospitals NHS Foundation Trust in 1998 and Honorary Professor at Teesside University in 2021. His clinical practice focused on arrhythmia and syncope management and cardiac implantable electronic devices.

Professor Linker was President of the British Heart Rhythm Society and Honorary Secretary of the British Cardiovascular Society. He was integral in developing UK standards for cardiac implantable electronic devices, electrophysiology and lead extraction and developed guidelines on MR scanning in patients with cardiac devices, peri-operative management of cardiac devices and end of life care pathways for cardiac device patients.

Dr Rajiv Sankaranarayanan is a consultant cardiologist and Heart Failure Virtual Ward Lead at Cheshire and Merseyside Integrated Care Board.