Can an ultrasound scan for older people with suspected heart failure improve care quality?

A research blog by Dr Emma Rees, Associate Professor of Healthcare Science, Swansea University.

This research is funded by Health and Care Research Wales’ 2022 Health Research Fellowships award. Read about all the latest funding call awards here – £6.4 million to support vital health and social care research in Wales

Why is this research needed?

An increasing number of older people experience significant shortness of breath, affecting their quality and length of life. It is sometimes difficult to determine the cause of this breathlessness, and a diagnosis might involve several tests and hospital appointments. This arrangement of services is very challenging for individuals receiving medical care in residential homes or community settings.

Nurses providing medical care in these settings rely on basic point-of-care tests, which have lower accuracy than specialist tests. As a result, there are likely to be significant variations in the care quality, including effectiveness, patient-centredness, safety and timeliness.

What are the aims of the research?

This project will assess whether an advanced nurse practitioner (ANP) can accurately perform a focused ultrasound scan (FOCUS) of the heart and lungs in a residential setting and whether this improves the quality of the community pathway for older people. Adding a test like this to an existing pathway can be quite complex, with significant challenges around implementation. Our study design takes a cautious approach of building evidence in phases to understand the context of the problem, refine the intervention and consider solutions for implementation barriers.

Hand-held heart scanner

The data we collect from this work will help us understand whether our findings can be generalised to other sites and settings and plan a large, multi-centre intervention trial in the future.

How will SAIL Databank be used in your research?

We will use routinely held, anonymised data in the SAIL databank to understand the scale and context of the problem in Wales, including the real-world pathway, diagnoses, outcomes, resource use and costs for a cohort of older people with breathlessness.

We will then look at the feasibility and acceptability of adding FOCUS to the current care patients receive. We will also explore factors that impact the effective implementation of the test in residential environments. This will help us to decide whether the idea is deliverable and acceptable before proceeding with an effectiveness study. The effectiveness study will directly compare diagnostic outcomes and costs of the current pathway with and without FOCUS.

We will link the data gathered from this effectiveness trial to that of the wider Welsh population data sources, within SAIL Databank, from beyond the residential and community care settings, paving the way for future research that could impact the broader system of care.

The potential impact of this research.

Improved understanding of breathlessness among older people.

Determine suitability of a care intervention for better health outcomes.

Lay the groundwork for wider research to improve healthcare quality for older people.