NICE recommends use of Manchester developed remote digital heart failure system to reduce hospital admissions

Innovative research in Manchester illustrates the potential to dramatically reduce hospitalisations by 58 per cent and improve patient care.

The National Institute for Health and Care Excellence (NICE) have released guidelines (Thursday 24 October) recommending the use of a remote heart monitoring pathway in people with cardiac implantable electronic devices (such as pacemakers) who have heart failure.

Researchers at Manchester University NHS Foundation Trust (MFT) developed the pathway ‘TriageHF’, in collaboration with Medtronic (medical technology company) and have proven how it can dramatically reduce the number of hospitalisations due to heart failure.

Many heart failure patients are fitted with a pacemaker or implantable cardioverter defibrillator (ICD) to help their heart to beat regularly and more effectively. These devices are continuously collecting health data about the person’s condition such as heart rate, heart rhythm, physical activity, and fluid build-up in the lungs, all of which can be used to assess the risk of being hospitalised.

The new approach, recommended by NICE, takes advantage of the remote monitoring capability of these devices and uses real-time data to automatically alert the hospital team when a person’s condition becomes ‘high risk’ of them being hospitalised within 30 days.

Dr Fozia Ahmed, Consultant Cardiologist at MFT, who led the research, said: “I am delighted NICE has recommended the use of the TriageHF pathway which will have a positive impact on patients across the country.

“We routinely see patients with heart failure in the hospital clinic for a check-up every six months, but we know that their condition can deteriorate rapidly between appointments. Having an automatic system that alerts us to early signs of deterioration enables us to intervene quickly, preventing hospitalisations and potentially deaths, due to heart failure.

“Additionally, from our experience of using this technology in Manchester we know that heart failure alerts can also lead us to pick up on other health problems a patient may be experiencing during our phone consultations such as pneumonia or frailty.”

Heart failure is a debilitating condition that impacts the lives of nearly one million people in the UK. It occurs when the heart is unable to pump blood around the body properly. Whilst there have been advances in therapies used to treat heart failure, it still remains a leading cause of unplanned hospital admissions and is the most common cause of admission in people over 65 years of age.

Through Triage HF monitoring, patients have a simple transmitter box attached to their phoneline which automatically sends alerts from the patient’s pacemaker or ICD to the Heart Failure Team at the hospital if any dangerous, abnormal readings are identified.

Following an alert, patients deemed at high risk of hospitalisation are then telephoned by the heart failure team and any changes that are needed to be made to help manage their heart failure in a different way are discussed and implemented.

Anthony’s story

Anthony, 74 from Nelson in Lancashire suffered a heart attack in 2010 and was later diagnosed with heart failure. He had a pacemaker fitted in 2014 and was referred to the Manchester Heart Institute at Manchester Royal Infirmary (MRI), part of MFT, for his care and treatment.

Anthony has more recently been recruited to research using the TriageHF technology to monitor his heart failure remotely. He describes the pathway as a virtual, supportive hug.

Anthony said: “My experience of using TriageHF has been lifechanging as it gives you the knowledge and confidence to move ahead and get on with your life, whilst having the reassurance that the hospital teams are supporting you remotely and are just at the end of a phone if there are any concerns.

“For me, nothing has changed day to day, but it has given me so much confidence. It’s like a virtual hug, knowing that I am supported and monitored by the fantastic hospital team.”

In November 2023, the device alerted the Heart Failure Team at MRI, who followed up with Anthony to discuss his symptoms and current medication. Anthony was feeling more breathless and attended the hospital to review his treatment but since altering his medication, feels he has a new lease of life.

“I used to struggle walking up the stairs without feeling breathless and would find day to day tasks, such as having a conversation, more of a challenge. Now I feel more in control and have even joined a gym. I have the freedom to enjoy life, without worrying.

“It’s terrific that this has been recommended for use with other patients across the country, like me, as it really does improve your quality of life, and it has so much potential for others with heart failure, in the future.”

“The dedication, commitment and support that I, and so many others have been given by the cardiac rehabilitation nurses and the professional cardiac support services of Up and Active has been fantastic. I thoroughly enjoy attending my weekly fitness classes which demonstrate the benefits of keeping fit to all ages, abilities and challenges.”

Research involving 758 participants with heart failure across three hospitals in Greater Manchester, including Manchester Royal Infirmary and Wythenshawe Hospital, both part of MFT, was published earlier this year in the European Society of Cardiology (ESC) Heart Failure Journal. It found that the rate of hospitalisation was 58 per cent lower in patients whose devices were monitored by TriageHF than those who received standard level of care from their device.

Dr Ahmed added: “For patients, this offers peace of mind that the hospital team is able to monitor them remotely and get ahead of any problems or changes which, if left untreated, could result in an admission to hospital.

“It is about using the technology contained within these devices to their full capability and developing pathways in the heart failure service within the hospital to ensure we can act on alerts we receive quickly. This is something we have pioneered in Manchester and have proven that this is replicable and scalable across different hospitals.”

Following the success of this research, TriageHF has been implemented in eight hospitals across Greater Manchester to further evaluate the performance of the remote monitoring system.