Under a collaborative working agreement between Boehringer Ingelheim and United Lincolnshire Hospitals NHS Trust (ULHT), a new cardio-diabetic in-reach and outpatient programme was created to streamline the service for patients with diabetes and recent heart attack.
Cardiovascular related complications are common in patients with diabetes. In Lincolnshire, around 1 in 3 (33%) patients with diabetes have a recorded history of cardiovascular disease, which is higher than the average of 29% observed for England2. Importantly, restoring and extending the benefits of secondary prevention measures, particularly in cardiovascular disease, through testing innovative care models, is a key priority for NHS England.
The clinical teams led by Professor Kelvin Lee, Dr Bala Srinivasan and Prof Alun Roebuck set out to improve the outcomes of patients with diabetes and cardiovascular disease. The doctors and nurses at the Lincolnshire Heart Centre and the Diabetes Unit at United Lincolnshire NHS Hospitals Trust have developed and established a new streamlined service to improve and optimise the management and care of patients with diabetes who have been admitted with a heart attack or acute coronary syndrome in our hospitals.
A previous project had highlighted that patient capacity was not always being met, leading to some patients being treated for the conditions separately, causing delays with repeated reviews, and missed opportunities for optimised care.
Now, working collaboratively during ward reviews, all eligible diabetic patients on cardiology wards receive input from both specialist teams, benefiting from cross-disciplinary knowledge that provides optimised medical therapy to compliment both conditions. This allows the opportunity to start the latest guideline recommended therapies of cardiovascular benefit for our patients in Lincolnshire.
The innovative in-reach and joint-speciality clinic is driven by cardiology Advanced Clinical Practitioners (ACPs), junior and middle-grade doctors, and supported by a consultant cardiologist, diabetologist, and a clinical research fellow, to provide a joined-up approach to the cardio-diabetic programme.
Alan Pearce, 67, from Irby in North-East Lincolnshire was rushed to Lincoln Heart Centre following a heart attack and was cared for under the new pathway.
Alan, said: “The care I received at Lincoln County Hospital was second-to-none, not just for saving my life, but for the follow up to help me understand more about my health to help me make the changes and manage my conditions to prevent this happening again.”
“On some level I knew there was a link between diabetes and heart attacks but I didn’t think too much of it. When I had my first heart attack I thought it was indigestion, it was only later that day when I called 111 for advice on taking indigestion and diabetes medication that I learned I was having a heart attack and was rushed to Lincoln County Hospital to have stents fitted.”
Professor Kelvin Lee, Consultant Interventional Cardiologist and Director of the Cardiovascular Research Programme at ULHT, said: “Before launching the new service, we knew that many patients with Acute Coronary Syndrome (ACS) with existing or newly diagnosed diabetes were not always being followed up in the separate cardiology or diabetes clinic, or by their GPs in primary care in a timely manner, nor had their cardiovascular-diabetic treatment subsequently optimised after being discharged.”
“Our partnership with Boehringer Ingelheim has allowed us to use our existing staff, and has included a focus on educating and training our cardiac ACPs, and adapting our current processes to provide a better service for our patients for a more joined up approach to their care.”
“Diabetes can be quite a daunting diagnosis for many patients, and for those who then also go on to have a heart attack or acute coronary syndrome. The easier we can make it to help our patients manage their conditions the better to help prevent future emergency situations such as heart attack, heart failure or cardiac arrest.”
The new pathway can also help to alleviate pressure on primary care networks by providing joined up care in an acute setting, before handing over care to GP services.
Dr Carl Deaney, GP at Marsh Medical Practice who leads long term condition projects in his Primary Care Network, said: “Patients with ACS and diabetes often require GP appointments in addition to outpatient appointments following an acute event (such as a heart attack) to help manage their conditions and the associated symptoms.”
“Complimentary treatments that are optimised for both ACS and diabetes can help reduce the need for GP appointments, and better education for patients to help them manage both of the conditions simultaneously rather than separately which may inadvertently cause other issues.
“As the service expands, further knowledge of the new clinic within primary care can help us to work closely with our colleagues in the Lincoln Heart Centre for better patient care.”
Dr Christoph Zehendner, Medical Director at Boehringer Ingelheim said: “We are proud to support the NHS as it continues to design, deliver and evaluate innovative models of care to improve patient outcomes and respond to the secondary prevention challenge.
“We share the goal of this dedicated team at Lincolnshire NHS Trust to ensure patients receive holistic personalised care. This partnership project is one of many that Boehringer Ingelheim is supporting to identify innovative models of care to ensure a sustainable future for the NHS.”
Since its inception in 2021, the cardio-diabetes service has now seen over 280 patients with diabetes following their heart attack or ACS, ensuring improved and optimised cardio-diabetes care. The service is being commissioned by ULHT to continue to provide this novel approach in healthcare for patients in Lincolnshire.
- Lautsch, Dominik, Tongtong Wang, Lingfeng Yang, and Swapnil N. Rajpathak. “Prevalence of Established Cardiovascular Disease in Patients with Type 2 Diabetes Mellitus in the UK.” Diabetes Therapy 10, no. 6 (December 1, 2019): 2131–37. https://doi.org/10.1007/s13300-019-00698-9.
- Quality Outcomes Framework Data 2021-22. URL: Quality and Outcomes Framework, 2021-22 – NHS Digital
- C J M Whitty et al “Restoring and extending secondary prevention”. BMJ 1st February 2023;380:p201
MPR-GB-100044 September 2023