Specialists in heart failure, together with a multidisciplinary team including physiotherapists, occupational therapists, dieticians, pharmacists and geriatricians at Leicester’s Glenfield hospital are working together to investigate the benefits of a new holistic approach to improving the care of heart failure patients.
“It’s not always straightforward to treat older patients living with heart failure,” explains Dr Shirley Sze, a Cardiology registrar and Honorary academic clinical lecturer at University Hospitals of Leicester NHS Trust.
“The heart failure patients we treat often also have other non-cardiac issues, such as malnutrition, sarcopenia (loss of muscle power and strength), recurrent falls, cognitive impairment and social isolation. They’re taking many medications and often struggle with keeping to them.
“To discover the best way to treat these complex patients holistically, we needed to carry out some research.”
Historically, older patients with heart failure have been excluded from taking part in trials, and so this study, funded by the British Heart Foundation and the National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre is the first of its kind in the UK.
In the research, heart failure patients have a comprehensive medical assessment evaluating different aspects of health, including medical history, medications, mobility and balance, diet as well as home environment and social support.
They were then invited to attend a ‘one-stop clinic’, together with their family members, where they learned about a chair-based home exercise programme and discussed personalised diet plans.
Seventy five patients across two NHS trusts have been invited to take part in the 12-week intervention. All patients were followed up every two weeks. Their quality of life and physical functioning were monitored throughout the study.
Apart from a heart condition, Sue Renshaw, age 72 from Leicester, was also living with arthritis and leukaemia. Sue was also having recurrent falls and so was invited to take part in the programme.
Sue said: “Everyone I spoke to was so welcoming, so supportive and made sure I understood everything about taking part. Being able to speak to all of those experts in one place was very helpful.
“They talked me through the exercises and dietary changes, which were all covered in the handbook and were very easy to follow at home.”
“I feel so much better since taking part. I’ve lost six kilograms in weight, increased my muscle mass and most importantly, my strength.
“I wasn’t leaving the house at all before taking part in the study, but I’m gaining strength and confidence, and am now walking down the road, walking outside further every day.”
“I hope the booklet and approach is rolled out to more people, and helps them too.”
When asked if she would encourage more people to take part in research, Sue said: “I’d definitely recommend the intervention to other patients. You have to be committed to taking part in all of the sessions but it could help you! It’s been a very positive experience for me, everyone’s been amazing.”
At the appointments, patients were encouraged to talk freely about their healthcare needs and concerns. The data gathered was discussed with a multidisciplinary team of healthcare professionals and a personalised care plan developed for each patient.
If required, there was also the opportunity for a review of their medications, other medical conditions as well as home and social support.
Dr Sze continued: “This holistic intervention package, as well as all supporting materials including an intervention booklet, exercise manual and videos, were co-designed and co-developed with heart failure patients, their carers and various healthcare professionals involved in delivery of care to these patients.
“This has ensured they are user-friendly and address the gaps in current heart failure care.
“The intervention is also currently being trialled at Portsmouth Hospitals NHS Trust. We’re coming to the end of the study, and the feedback we have from patients, carers as well as healthcare professionals involved in delivering the intervention have been very positive.”
“We hope our findings will not only contribute to improving the future care of patients with heart failure, but also those living with other chronic health conditions, such as diabetes, lung or kidney problems.
“This work highlights a critical shift in how we treat patients, encouraging a move away from disease-specific management toward integrated, patient-centred care.
“Holistic care models should serve as the foundation for interventions designed to address the complex and multifaceted needs of individuals with multiple long-term conditions.”