Echotech Ltd was established in 2001 to provide echocardiography services to NHS patients across the UK in the community setting. This flexible, patient-led service depends on nine point-of-care ultrasound tools to assess patients in a variety of community-based locations, delivering a rapid, quality-assured service that is drastically reducing echocardiography waiting lists.
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Heart failure affects an average of eight people in every 1,000 of the UK population1 and studies have clearly demonstrated that prevalence increases with age1,2. Once diagnosed, appropriate treatment and ongoing support can improve the quality of life for heart failure patients, and help to reduce morbidity and mortality.
Echocardiography provides a painless, non-invasive method to image the heart using ultrasound, giving detailed information on the structure of the heart and the direction of blood flow through its chambers. Current echocardiography systems allow the function of the heart’s muscle tissue and blood flow to be objectively assessed with relative ease, and both the UK Department of Health3 and NICE guidelines4 require echocardiography to be carried out on all patients with suspected heart failure. With many cardiology departments at full capacity, there are long waiting lists for these diagnostic procedures, however the NHS Improvement Plan5 pledges that, by the end of 2008, no one will wait longer than 18 weeks from GP referral to hospital treatment.
The Portsmouth-based company Echotech Ltd, which provides diagnostic services for patients with suspected heart failure in the community, offers a potential solution for this daunting target and its service model has real implications for the future of cardiology. By streamlining the diagnostic process, and using the latest technologically advanced point-of-care visualisation tools, the company can reduce a hospital’s cardiology appointments to only those patients known to require specialist hospital services. NHS resources can be more cost-effectively distributed, waiting times are drastically reduced and hospital doctors are able to concentrate on patient treatment.
Echotech depends on nine Sonosite MicroMaxx® ultrasound systems to provide high performance echocardiography within the primary care setting. The point-of-care systems offer sufficiently high quality imaging and resolution for thorough and accurate cardiac assessment6, and bring about massive cost-savings to the NHS, as a few machines can be used safely across a large number of sites. They also ensure the robustness, flexibility and reliability needed for the mobile service. Echotech records all scans using a medical DVD recorder that connects directly to the ultrasound system, allowing easy transfer of patient files to GPs or hospital cardiology departments as necessary.
Keli Glover, Clinical Operations Director and cardiac physiologist at Echotech explained, “We provide echocardiography services to many regions across England, such as London, Portsmouth, the Isle of Wight, Worthing, East Surrey and the West Midlands. The service varies according to the primary care trust (PCT)’s requirements. For example, we often provide clinics for open-access GP referrals: the GP refers the patient for the echo, which we carry out, then the report goes back to the GP. Alternatively, we provide cardiology clinics, where a cardiologist from the local hospital runs a clinic in the community and we provide echocardiography and electrocardiograms for the patients before they go in to see the cardiologist.”
Echotech is exclusively contracted to the NHS and its British Society of Echocardiography-accredited cardiac physiologists ensure high standards of quality when investigating patients. “We use a variety of NHS centres within the community, and we have some mobile units that allow us to provide evening and weekend services, which make it easier for many younger patients to come to appointments,” Keli continued. “We have now scanned over 10,000 patients, and we see 90 per cent of our patients within 14 days of referral.”
After each patient investigation, Echotech sends a report that is made available to the referring clinician on the day of the scan, with details such as the degree of LV function (systolic and diastolic) and any other abnormality. Serious problems can be instantly dealt with by contacting the GP while the patient is present, for immediate follow-up or hospital admission if necessary.
Echotech’s service offers several benefits to patients and healthcare professionals, in particular by offering early and accurate diagnosis of heart failure, while simultaneously helping to reduce waiting lists. Echotech allows the right patient to receive the appropriate treatment at the optimal time, improving health and helping with risk stratification such as early identification of those patients requiring specialist assessment. A proportion of the patients that Echotech has seen appear to have normal cardiac function and a recent audit of the company’s study database (cohort 10,000 patients) revealed that fewer than 20 per cent of investigations led to the patient requiring specialist referral, demonstrating a significant sparing effect on NHS resources7.
Improved access to echocardiography may also result in higher rates of optimal pharmacological intervention8, such as with ACE inhibitors and beta-blockers, and could, as a consequence, lead to decreases in morbidity, mortality and hospital admissions9,10. Importantly, the service conforms to the NHS Plan11, which highlights the need to improve access to services by redesigning care pathways around the needs and convenience of the patient.
“Previously, it could take up to a year for a patient to go from an initial GP’s referral for an echo to actually receiving the test results – which is far from ideal, particularly if the patient is seriously ill. All of our patients appreciate the fast turnaround times and many of them feel more comfortable coming to a local clinic or mobile unit than travelling to a large hospital. We recently carried out a survey of our patients in East London and found that the patients were 99 per cent happy with all aspects of the service, which is a brilliant outcome,” Keli added.
References
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Majeed A, Williams J, de Lusignan S, et al. (2005) Management of heart failure in primary care after implementation of the National Service Framework for Coronary Heart Disease: a cross-sectional study. Public Health 119: 105-111.
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Davis RC, Hobbs FD, Lip GY (2000) ABC of heart failure. History and epidemiology. British Medical Journal 320: 39-42.
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Department of Health (March 2000) National Service Framework for Coronary Heart Disease: chapter 6, standard 11.
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NICE Clinical Guideline 5 (July 2003) Chronic Heart Failure: Management of chronic heart failure in adults in primary and secondary care.
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Department of Health (June 2004) The NHS Improvement Plan: Putting people at the heart of public services.
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Senior R, Galasko G, McMurray JV, Mayet J (2003). Screening for left ventricular dysfunction in the community: role of hand held echocardiography and brain natriuretic peptides. Heart 89(Suppl 3): iii24-iii28.
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Catterall V. Echocardiography in primary care: evaluating an open access service. http://www.somerset-health.org.uk/pdf/ha_reports/echocardiography.pdf
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Lillis S, Vickers J. Assessment and treatment of heart failure in general practice. http://www.priory.com/fam/heart.htm
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CIBIS II (1999) The cardiac insufficiency bisoprolol study II: a randomised trial. Lancet 353: 9-13.
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SOLVD investigators (1991) Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. New England Journal of Medicine 325: 293-302.
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Department of Health (July 2000) The NHS Plan: A plan for investment, a plan for reform.
