A new approach to delivering palliative at-home treatment to advanced heart failure patients in Wales has been hailed a success – with hopes the award-winning model can be rolled out nationally.
For six years a team at University Hospital of Wales has championed offering infusions at home for suitable heart failure patients who are at end of life, thanks to support from district nurses who manage daily treatments via 24-hour syringe drivers.
This model was used in about 10-15% of cases, and while it achieved its aims - to give patients their preferred place of care and place of death and reduce hospital admissions - the solution was costly and resource-intensive, until now.
A 12-month pilot, using an Accufuser elastomeric pump from medical device company Vygon, has allowed for continuous seven-day infusion to replace a daily routine.
The portable elastomeric infusion pump is specifically designed for the delivery of continuous flow infusions over a sustained period. It was used to give patients pre-prepared furosemide, in a formulation with a shelf life across the seven-days required, after being thoroughly assessed and produced by the hospital pharmacy.
With 12 patients in Wales trialling the model over the past year, the hospital has calculated financial savings of over £1,500 and a reduction of district nurse time by 104 hours, per patient. The trial also positively impacted the carbon footprint of the community nursing team, due to fewer trips to and from patients’ homes.
Dr Clea Atkinson is consultant in Supportive and Palliative Care at University Hospital of Wales, Cardiff and led the project.
She said: “While our existing approach had proven valuable in managing patients in the community in the last year of life, it also carried associated costs and human resource implications.
“This project offered a positive patient experience by allowing for care and the option to die where they wished – and for most this was at home. But we also succeeded in reducing adverse events and lessening the burden on hospital admissions, making the care more cost-effective, while improving the environmental impact.
“We are now undertaking research among district nurses to gain their valuable feedback to inform our next steps, and we hope, if we can batch produce the seven-day stable formulation, we can scale this model up to be rolled out across the country for advanced heart failure patients, including those in rural areas of Wales.”
In the 12 months since the service was established, 12 patients received this new treatment method. Preliminary data shows that patients benefited from (mean average) 3kg fluid loss, a reduction in fluid swelling in the arms and legs (peripheral oedema level of at least 1 point) plus improvement in reported pain intensity and breathlessness (a visual-analogue-scale score of 2).
Vygon product specialist Iona Mackenzie added: “The results of this pilot are really encouraging, considering it means patients who are in end stage heart failure, to have their pump changed weekly rather than daily, allowing them to maintain some semblance of a normal life.
“The benefit of the Accufuser is that it is simple enough to be used by the patient or carer. Palliative care of this nature can last for months, maybe even a few years, so it’s important that the pump is comfortable to wear, easily portable and discreet.”
The Accufuser elastomeric pump from Vygon is available in four sizes, 60ml, 100ml, 300ml and 600ml and flow rates can be adjusted from 0.5ml per hour, up to 250ml per hour. As well as diuretics treatment, the device can be used for antibiotic infusions, pain management and chemotherapy.
The collaboration between University Hospital of Wales’ Supportive Care Service (SCS) and Vygon was honoured at the seventeenth annual MediWales Innovation Awards, which were held on 8 December 2022 in Cardiff.
