Virtual ward for AF ‘could prevent thousands of admissions a year’  | Nursing Times

The researchers behind the initiative, which has been trialed so far in the Midlands, now hope to expand it to other parts of the country.

“It is delivering hospital level care for patients in the comfort of their own home”

André Ng

The study authors from Leicester University, including advanced nurse practitioner Sue Armstrong, presented their research this month at a British Cardiovascular Society conference in Manchester.

In their year-long study, patients with a fast heart rate due to atrial fibrillation or atrial flutter, that met safety criteria, were sent home with the heart rate-lowering medication they would usually get in hospital, and told to submit daily information using a smartphone app.

Their data, including ECG recordings, blood pressure, oxygen saturation and answers to an atrial fibrillation symptom questionnaire, were closely monitored by specialist nurses and doctors at Glenfield Hospital, who made treatment decisions remotely.

The researchers noted that the conventional arrangement involves patients being monitored for several days in hospital, adding to the ongoing pressure on the NHS.

They also highlighted that atrial fibrillation was the most common form of abnormal heart rhythm and believed to contribute to one in five strokes. One in 45 people in the UK are diagnosed with it.

Professor André Ng, head of the Department of Cardiovascular Sciences at Leicester, said: “By using the data patients collect to make treatment decisions on a day-to-day basis, this virtual ward is not simply monitoring patients.

“It is delivering hospital level care for patients in the comfort of their own home,” said Professor Ng.

“This is a great opportunity to prevent thousands of hospital admissions each year before they’ve even begun, saving the NHS precious time and money when it needs it most,” he said.

During the single-hospital trial between January 2022 and January 2023 there were 118 virtual admissions, 66 – equivalent to 55% – of which were ‘step-up’, where the virtual ward was used instead of hospital admission.

The remaining 45% were ‘step-across‘, where early hospital discharge was possible thanks to the virtual ward.

As well as 66 ‘step-up’ admissions, 61 re-admissions were safely stopped, meaning that 127 unplanned hospitalisations were prevented, saving an estimated 444 days in hospital for patients.

The findings also showed the average heart rate reduced from 124bpm at when patients were admitted to the virtual ward to 84bpm when they were discharged.

The clinical team also developed and used e-pharmacy measures to ensure they could change patients’ prescriptions quickly, if needed.

Professor Sir Nilesh Samani, medical director at the British Heart Foundation, said: “We’ve seen time and time again how the pressure on the NHS is compromising heart and circulatory disease care, with constant shortages of hospital beds and long waiting lists.

“This trial shows that we can use the latest healthcare technology to ease this pressure and free up space,” he said.

“The positive treatment outcomes and high patient satisfaction seen in this study show that we don’t have to make compromises when saving time and money on atrial fibrillation treatment.”

The researchers said they now planned to use new funding from the British Heart Foundation to scope out the implementation of the virtual ward beyond Leicester to several other NHS centres.