Empowering early intervention in heart failure - improving outcomes, reducing readmissions.

The heart failure pathway aims to enable the proactive management and continuity of care for people living with heart failure. Through regular remote monitoring of vital signs and a structured symptom checker questionnaire, clinicians can identify early signs of deterioration and intervene before hospital admission is needed. The same approach supports safe, timely discharge, allowing patients to recover at home while remaining under clinical oversight.

With an easy-to-use, intuitive dashboard, clinicians can closely monitor patients, with those requiring follow-up automatically highlighted through intelligent algorithms that analyse symptom data and vital signs . By connecting care across acute, community, and primary settings, the pathway aims to help reduce readmissions, improve outcomes, and ease pressure on hospital capacity.

The heart failure pathway at a glance: how it works

  • Clinicians enrol patients through a quick referral form, capturing key details, baseline readings, and communication preferences.
  • Once onboarded, patients appear on the ward dashboard for remote monitoring and regularly submit vital sign readings and responses to a simple symptom checker questionnaire – via their preferred device or communication method.
  • The RAG-rated dashboard gives clinicians a clear view of all patients, and alerts are raised when thresholds are breached, highlighting those most in need of follow-up. Clinicians can review responses, adjust settings, and document actions directly within the Inhealthcare Platform.
  • Daily summaries and SNOMED-coded data are automatically uploaded to EMIS or SystmOne, with clear colour-coded responses showing patient status and a discharge summary generated when monitoring ends.
Benefits and aims

Delayed recognition of deterioration – with frequent monitoring, the service aims to enable earlier intervention.

Fragmented care – the service aims to bridge the gap between acute and community settings.

Revolving-door admissions – the service aims to support early detection to help reduce 30-day re-admissions.

Workforce strain – the service aims to reduce travel and administration time for heart failure nurses.

Bed capacity pressure – the service aims to enable early discharge and home recovery.

Rising complexity – the service aims to help prioritise and manage complex caseloads more effectively.

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