Leeds Teaching Hospitals Trust (LTHT) has recently established an innovative cardiometabolic clinic as part of a joint working partnership project with the pharmaceutical company Boehringer Ingelheim.
Around a quarter of patients who suffer a heart attack have Type 2 diabetes, and the presence of diabetes increases the risk of death by more than two and a half times when compared to heart attack patients who don’t have the disease2.
The clinic focuses on reducing cardiovascular risk in people with diabetes who have recently been discharged from LTHT following a heart attack. It is delivered jointly by the cardiology department at Leeds General Infirmary and the diabetes services at the Trust. This is a patient-centred approach to reducing that risk, with pharmacist-delivered clinics scheduled for 6-8 weeks after the heart attack.
Stephen Wheatcroft, Professor of Cardiometabolic Medicine and Consultant Cardiologist at LTHT, says: “This is an exciting and innovative development, one of the first in the country. Previously, Type 2 diabetic patients presenting with heart issues would have been treated by two separate specialty teams. This is the first time there has been a specific clinic combining the cardiac and diabetes team working together. We aim to reduce the risk for patients, with earlier multidisciplinary hospital care, to help discharged patients achieve better diabetes control, through improved medication support and optimisation, reducing the need for further treatment and future hospital stays. Overall, it will mean a better patient experience, with improved monitoring and information about treatment options, along with a reduction in waiting times for review in a specialist clinic.”
Patients used to be referred to their GP surgeries for their diabetes control, but after one year over half of patients were found to have worse control. The new service will explore the barriers to patients taking their medication and look to address the patients’ needs, including education and self-management, and help patients discharged from the clinic to have better diabetes control, through using their medication and helping with the reasons they might not take it.
Patients will receive an extended consultation of one hour with the consultant or specialist pharmacist who will optimise both the cardiovascular and diabetes medications. This should reduce waiting times for appointments and the need for multiple consultations. Several recent studies have demonstrated the protective effects of certain diabetes medications on the heart and circulation.
This clinic will help to offer maximum protection by early intervention to reduce risk factors, including glucose control, which often has room to be improved in these individuals.
Dr Rani Khatib, Consultant Pharmacist in Cardiology & Cardiovascular Research says “This is a new exciting opportunity to deliver a person-centred combined heart and diabetes optimisation service. We will work with people to explore and address their concerns and barriers to taking heart and diabetes medicines, reduce risk of having further complications, achieve better diabetes control, and provide education and better self-management. This combined, holistic approach will lower the risk of further health issues for patients and reduce the number of appointments they must attend. This means they are less likely to require unplanned primary care or future hospital admissions. Along with better outcomes for patients this innovative approach should reduce the demand on services – a vital contribution to the NHS during pandemic recovery.”
A patient Robert, 57, said: “I didn’t know having diabetes has an impact on my heart. Having a clinic that addresses the heart and my diabetes would be great and makes perfect sense.”
Pauline, who is 83, said “Not having to attend separate clinics and getting my medicines all optimised in one appointment would be good and would save me a lot of time.”
Julie, 63, said “I just had a heart attack and was started on a lot of new medicines. With everything happening in the hospital, it is difficult to remember what people tell you. Knowing I will have a dedicated clinic review to address my individual risk and medicines will make me feel safer when I leave hospital.”
David Wardman, Pharmacist and Clinical Lead for Long-Term Conditions at NHS Leeds CCG, says: “This innovative clinic represents an important step forward towards our ambition of creating greater person-centred care that focuses on addressing the whole needs of people rather than treating each condition separately. Heart disease and diabetes are very closely linked with devastating consequences if not treated optimally. Combining support for these two important areas should mean that people are able to have better conversations about their health and get more tailored support.”
Dr Naj Rotheram, Medical Lead for Partnerships at Boehringer Ingelheim said: “We are proud to support the NHS as it continues to design, deliver and evaluate innovative models of care to enhance patient experience and improve outcomes. We share the goal of this dedicated team at Leeds NHS Trust to ensure patients receive holistic personalised care. This project is one of many that Boehringer Ingelheim is supporting to identify innovative models of care to ensure a sustainable future for the NHS.”
The project is led by Cardiology Consultant Pharmacist, Dr Rani Khatib, with support from Professor of Metabolic Medicine and Consultant in Diabetes and Endocrinology Ramzi Ajjan and Professor of Cardiometabolic Medicine and Consultant Cardiologist Stephen Wheatcroft, with Patricia Lenk – Advanced Clinical Pharmacist – Cardiometabolic medicine.
