Development of an applied research programme to improve heart failure services and outcomes in Wales (IMPROVE-HF)

Background: Heart failure (HF) is common (affecting over 1 million people in the UK) and associated with high healthcare-resource use. UK guidelines recommend the best approach to detection and treatment, but in practice approaches and outcomes are often varied and sub-optimal. There is variation in identifying at-risk individuals, accessing tests like echocardiography (echo), optimising medication, monitoring for deterioration, and referring to rehabilitation and palliative care. In Wales, multi-disciplinary HF services have been set up to improve outcomes, but these are often shaped by organisational constraints rather than patients’ needs. People tend to be diagnosed late when disease is more severe, and many do not receive evidence-based treatment. Information sharing between HF teams is variable and few healthcare professionals are research active. There is consequently a lack of high-quality HF research, and no clear national approach to trialling new interventions that may lead to improved outcomes at scale. Aim: To complete development work for a future NIHR funding application for a cross-Wales, interprofessional programme of applied/health service research that improves early HF diagnosis and outcomes. Objectives: Establish a community of academics, health professionals, and public contributors to develop an integrated programme of HF research in Wales. Through 4 work packages (WPs), this community will: WP1. Summarise existing HF services, identify potential trial sites, and share ideas on novel interventions; WP2. Synthesise evidence of the effectiveness of HF service interventions in Wales, and propose service interventions to be tested in a trial, these could be new interventions, adaptations, or those being used elsewhere; WP3. Test the feasibility of a new process for linking echo data with other primary- and secondary-care datasets; WP4. Develop a cross-Wales consensus on which service interventions and outcome measures should be included in a programme of HF research. Methods: Development work will be led by two healthcare scientists, supported by a strong interprofessional team which includes pharmacists, nurses, doctors and methodological experts from Swansea Trials Unit. WP1 (months 1-3): A Wales-wide search for relevant services will be completed and an ‘Expression of Interest’ questionnaire disseminated. Appropriate teams will be invited to a ‘sandpit’ event to map the current provision of HF services, challenges, and opportunities. WP2 (months 3-8): Systematic review and meta-analysis of the effectiveness of HF service interventions informed by WP1 with pre-defined protocol registered on PROSPERO. WP3 (months 1-7): Determine feasibility of extracting echo measurement data from one site in NHS Wales and quality of HF data linkage with other primary and secondary care datasets. WP4 (months 8-12): Modified Delphi exercise to reach interprofessional consensus on the trial interventions and outcome measures to be included in the forward programme of HF health service research. Outcomes, dissemination & impact: Development of a strong submission to a future NIHR programme or project grant. Findings of WP2, 3 and 4 will be submitted for publication in academic journals. Accessible reports will be shared with those who might benefit from the work. By growing the research capability and reputation of our HF research community in Wales, we will increase opportunities for wider UK/international collaboration.