P32 Delivering pulmonary hypertension services—5 year experience from a Satellite centre

Introduction There are currently no National Commissioning Group (NCG) designated Pulmonary Hypertension (PH) centres in the South West. As a result patients can travel up to 300 miles to access specialist care. In 2005, a satellite service was developed at the Royal United Hospital (RUH), Bath in conjunction with the Royal Free, London. Initially the service simply provided a follow up service for patients known to the Royal Free. Since 2007 the service has fully investigated and managed new referrals locally, with supervision from the Royal Free. Patients have typically only needed to travel to an NCG centre for initiation of parenteral prostanoid therapy or for pulmonary endarterectomy (PEA). Aim This abstract describes the first 5 years of activity by the RUH satellite PH service. Results As of 1st July 2010, 147 new referrals have been received, increasing steadily from 7/year in 2005–2006 to 57/year in 2009–2010. Referrals originated from 7 specialities across 12 PCTs, with 48.6% from outside the immediate catchment area. 43 patients were diagnosed with Pulmonary Arterial Hypertension (PAH) (including 34 with Connective Tissue Disease-related PAH), 21 with Chronic Thromboembolic Pulmonary Hypertension (CTEPH) (including 15 referred for PEA surgery), 13 with PH associated with lung disease, 24 with PH associated with left heart disease. PH was excluded in 45 cases. 62 have received PH-specific medication; 38 monotherapy and 24 combination therapy (including 7 intravenous, 1 subcutaneous and 2 nebulised prostanoid therapy). Survival data for the 38 treated WHO Group 1 PAH patients compares favourably with published data for NCG designated centres; 89.5% at 1 year (95% CI 74.2% to 96.6%), 82.3% at 2 years (95% CI 65.9% to 92.2%) and 77.2% at 3 years (95% CI 60.3% to 88.6%). 489 journeys were made to the RUH and only 60 to NCG centres, saving approximately 56 000 patient miles. A recent patient survey indicated high levels of satisfaction, with 94.4% stating they would rather continue follow-up locally. Discussion These results suggest that a comprehensive PH specialist service can be delivered locally in a way that is more convenient for patients whilst still maintaining national standards of care.