In the last year[i], more than 6,300 tests have been performed nationally using AHSN-supported technology to help clinicians rapidly diagnose patients with suspected coronary artery disease.
The HeartFlow FFRct Analysis works by utilising coronary Computed Tomography (CT) scans to create a 3D model of the coronary arteries and assesses the impact of narrowings that may reduce blood flow to a patient’s heart muscle.
By providing information about anatomy and the functional significance of a narrowing, the software has been shown to reduce the need for invasive diagnostic angiograms by approximately 61% in studies. This benefits patients and the NHS workforce by improving patient experience, mitigating against risk factors and by creating efficiencies in chest pain pathways. HeartFlow is also endorsed for use by the National Institute of for Health and Care Excellence (NICE).
HeartFlow is an innovation on the Accelerated Access Collaborative’s (AAC) Rapid Uptake Products (RUP) programme and the new MedTech Funding Mandate. The AHSN Network is a key member of the AAC, an NHS England and NHS Improvement initiative to remove barriers and accelerate the introduction of groundbreaking new treatments and diagnostics to transform care. The AHSN Network is the delivery arm of the RUP programme, with all 15 AHSNs working with their local health and care partners to support the uptake of the selected innovations.
HeartFlow at University Hospitals of North Midlands NHS Trust
University Hospitals of North Midlands NHS Trust (UHNM) caters to a population of three million within Staffordshire. It has one of the top three busiest Regional Trauma centres and one of the five biggest cardiothoracic surgery centres in the UK, and generates a sizeable amount of cardiac and thoracic imaging work.
UHNM first adopted HeartFlow in April 2018 as part of the Innovation and Technology Payment (ITP) programme, which the AHSNs supported until April 2021. They were also signed up with a clinical trial called FORECAST – a national study to understand the benefits of combining cardiac CT along with the non-invasive Fractional Flow Reserve (HeartFlow FFRct).
Before adopting HeartFlow and being able to use the FFRct data, UHNM had already established a strong treatment pathway with Computed Tomography Coronary Angiography (CTCA) as the primary investigation tool for patients with low to intermediate risk stable chest pain.
Patients would typically be referred from nurse-led chest pain clinics for a cardiac CTCA. Dependent on the results, they would either be discharged with appropriate medication or receive further layered tests. These tests would either be functional imaging or invasive imaging such as an invasive coronary angiogram.
Dr Simon Duckett, Consultant Cardiologist at University Hospitals of North Midlands NHS Trust said: “One of the main benefits of using HeartFlow in our current pathway is that we can understand the anatomy and physiology with one scan. This allows us to get more information about a patient’s condition much quicker, which helps with more efficient clinical decision making by avoiding the need for other tests, while gaining a better understanding of which patients require invasive tests.
“Since then, FFRct has become a firm part of our treatment pathway for patients with stable chronic chest pain.”
In the last year, University Hospital North Midlands (UHNM) performed approximately 2,000 coronary Computed Tomography Coronary Angiography (CTCA) scans, of which 205 were sent for HeartFlow FFRct. A service evaluation showed approximately 50% patients that had FFRct did not have a significant narrowing and therefore did not require further investigations. Out of the patients who had a significant narrowing detected by FFRct and underwent invasive coronary angiography, 70-75% went on to have a revascularisation procedure. This was either via a stent within one or more of the coronary artery or referral for coronary bypass surgery. The improved selection of patients requiring invasive angiography improves the cardiac catheter lab efficiency and reduces the risk to patients by limiting the need for invasive testing.
When commenting on why UHNM implemented HeartFlow and some of the challenges, Simon said:
“I’ve always believed it is important to be at the forefront of innovation and new initiatives. The UHNM team, from radiologists to radiographers and cardiac assessment nurses, were all heavily involved and supportive in the implementation process, making it a really positive experience.
“The difficulty is that there’s no one-size-fits-all solution. Every trust is different and manages their work slightly differently, so setting up HeartFlow to work with the NHS IT and our existing systems was probably one of the biggest challenges. Once the HeartFlow and NHS IT teams were in the same room, it literally took five minutes for them to set it up.
“There was of course a learning curve getting used to the new system and understanding the analysis, but we embraced HeartFlow and it’s now an essential part in our diagnostic pathway when making decisions with regards to our patients.
“To the patient, they are still getting the same CT scan as they would have before, but the difference to the clinician is that we get more information and are able to see both the anatomy and physiology all together. It helps us establish more quickly the level of narrowing in an artery and whether it is causing a problem with the blood supply and decide on next steps in terms of treatment.
“I firmly believe HeartFlow FFRct makes the work we do more efficient and is safe for patients.”
Visit the AAC website, to find out more about HeartFlow and the other RUPs.
[i] April 2020–end of March 2021