Managing Heart Failure at Home

Patient Information
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What is the Managing Heart Failure at Home approach?

Managing Heart Failure@Home is a new way of looking after people with heart failure. The aim of Managing Heart Failure@Home is to help people manage their condition better and keep well at home.

The Managing Heart Failure@Home approach has three core elements:

• Personalised care - putting patients at the centre of the care we provide.
• Integration of care - improving the coordination of care between hospital and community services.
• Home monitoring - monitoring patients' health from the comfort of their home.
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The new approach could help patients to recognise when their condition is getting worse, so that they can get help earlier. This could lead to better outcomes and fewer emergency admissions to hospital.

Who is running the service?

The Managing Heart Failure@Home project is being funded by NHS England. East and North Hertfordshire Health and Care Partnership is one of ten sites that has been chosen to trial the new approach. 

The Heart Failure Specialist Nurses at the Lister Hospital will identify suitable patients. They will work with the patient to develop a personalised plan. They will also monitor the health measurements that the patients send from home.

East and North Hertfordshire Health and Care Partnership is working closely with Hertfordshire Community Trust (HCT) Hub. The nurses at HCT Hub will be keeping an eye on patients' health measurements. They will report any concerns to the Heart Failure Specialist Nurses at the Lister.

East and North Hertfordshire Health and Care Partnership are working with Doccla. Doccla is a health technology company who will supply the monitoring equipment. Doccla will also be helping to collect data about how well the new approach works.‍

How could Managing Heart Failure@Home help you?

Managing Heart Failure @home is one way to make sure you have the treatment, support and care you need. To do this, you will be offered:

1. A Personalised Care and Support Plan to help give you more control of your own health and care choices. The Care and Support Plan will be produced by you and your team. It is based on what matters to you in your life and your physical, emotional and social needs. The plan will ensure your needs are listened to and acted on by your team.
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2. Education on how to manage your heart failure and referral to specialist services. This might include cardiac rehabilitation, health coaching and/or supported self-management. Learning how to manage your condition can help to improve your confidence and wellbeing.
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3. The home monitoring service to monitor your health measurements, (such as heart rate, blood pressure or weight) from your home. This could help you to know when things are getting better or worse and when to ask for more support from your team. The nurses at HCT Hub will be able to see your measurements on their computer dashboard. They will contact you and your Heart Failure Specialist Nurses if they have concerns about your health. They may call you to talk about how you are feeling or change your medication, without you having to come to an appointment.
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What do you need to do?

We want to understand the impact of Managing Heart Failure at Home. To do this, we are asking patients to do 3 things:

1. Use the monitoring equipment to take your health measurements every week and enter them into a patient app. You will be given a Doccla box with all the equipment and a Doccla nurse will explain how the system works.
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2. Fill in a questionnaire about your health and quality of life at 3 key points during the project. We will ask you to fill in the questionnaire when you start the home monitoring, then again after 3 months and again after 6 months. This will help us to track how you are feeling and understand if the service is working well.
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3. Fill in a questionnaire about your experience of using the service at 3 key points during the project. We will ask you to fill in the questionnaire when you start the home monitoring, then again after 3 months and again after 6 months. This will help us to understand what is working and well and what we need to improve. 
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By participating, you'll help us learn more about using remote monitoring for heart failure patients. This could lead to better healthcare for people with heart failure in the future.

How will my information be used and shared?

Personal information might include your name, address, date of birth, gender, medical history and ethnicity. It also includes your vital signs and your responses to the questionnaire in the patient app.  

Who can see my personal information?

Personal information about your health will be shared with staff who are directly involved in your care. This may include hospital staff, community teams, emergency services and Doccla support staff. 

Doccla will also collect your completed questionnaires (at baseline, 3 months and 6 months) and share your responses with NHS England. Your responses to the questionnaire will be linked to your NHS number, which means that you can be identified. However, the data we collect will be stored securely and only seen by authorised staff working on the project. 

How will my personal information be shared?

Personal information will only be shared via NHS approved web-based health portals with authorised clinicians and licensed operators.

Why will my personal information be shared?

We will only share your personal information if it is about your care, keeping you safe or evaluating the service. 

If you do not want your information used and shared in this way, contact your Heart Failure Specialist Nurse on 01438 284574

What if the Managing Heart Failure@Home is not right for me?

You can choose whether Managing Heart Failure@Home is right for you. You and your multidisciplinary team can talk about this together. If you don't feel it is right for you, you can talk to your team about other care options.

If you start Managing Heart Failure@Home then decide that it is not for you, you can change your mind. If you change your mind, speak to your Specialist Heart Failure Nurse.