Family doctors are already enrolling in the landmark, unprecedented international ESCAPE trial announced by the SNHF. They want to assess whether integrated and personalised treatment and patient care improves the coping, physical and mental health of elderly patients with chronic heart failure who have multiple co-morbidities. The ESCAPE project is being implemented as a “Horizon2020” European Union Call for Proposals. The Hungarian partners of the project are the Heart and Vascular Clinic of Semmelweis University and the Institute of Behavioural Sciences. Dr. Csaba Móczár, internist, hypertension general practitioner, assistant professor at the Department of Family Medicine, Semmelweis University, applied for the study after reading our call.
“I was very impressed that there is a programme where we can really assess the needs of patients and what they can really get from it. This disease causes a serious lifestyle restriction, which is difficult to manage in a GP practice on our own for the time being. I run a practice of three thousand people, where you can really measure the time spent with patients in minutes, and you cannot give psychiatric or any kind of comprehensive support during that time, but I can see and feel that there is a lot left in them. In the Three Generations for Health programme – cardiovascular prevention in primary care, we were able to provide physiotherapy, psychology, mental health support for years, but now that has stopped. But it has
However, we have already seen in this programme that it is very important to provide extensive patient support, which such a study can give an even more accurate picture of,” said Dr. Csaba Móczár.
And what is this study?
In addition to heart failure, patients over 65 with at least two other comorbidities can apply for the EU research programme, which is being carried out in collaboration between the City Major Heart and Vascular Clinic of Semmelweis University and the Institute of Behavioural Sciences to investigate the extent to which psychosocial support affects patients’ condition, quality of life and life prospects.
An international study, ESCAPE, has been launched to provide integrated, patient-centred, psychosocial care to patients over 65 with heart failure and multiple co-morbidities (multimorbid) who are struggling to cope with their illness and its emotional burden. During the study, patients will receive practical and emotional support from a care coordinator with a tertiary level medical qualification for 9 months. The assessment of the patients’ condition and quality of life is done by questionnaire, telephone or video calls, and the participants do not have to travel anywhere,” said Dr. Klaudia Vivien Nagy, cardiologist at the City Major Heart and Vascular Clinic, who is the study’s leader.
Candidates will first take part in a survey, the results of which will determine their admission to the programme. In addition to the presence of chronic heart disease and co-morbidities, psychosocial elements are assessed, such as the patient’s ability to manage the disease and the emotional stress associated with it, to follow medical instructions, to take medication properly, to follow lifestyle advice.
The care coordinator helps the patients enrolled in the programme to do just these things, following the whole treatment strategy of the patient, discussing in detail how to take their medication, advising on lifestyle factors, nutrition, addictions, exercise, stress management and where to go for help with acute problems,” explained the researcher. Dr. Klaudia Vivien Nagy added that patients can also talk to the care coordinator about many important factors that determine the progress of the disease, quality of life and life prospects, which they do not have time to discuss during a doctor’s visit, and their lack of information significantly increases their mental stress level.
The National Patient Association SZÍVSN is one of the initiators of the study, because it is monitoring what the patient organisation is working for: the effectiveness of patient education and patient management. They want to assess whether integrated and personalised treatment and patient care improves the coping, physical and mental health of elderly patients with chronic heart failure and multiple co-morbidities. The ESCAPE project is being implemented as a “Horizon2020” European Union Call for Proposals. The Hungarian partners of the project are the Heart and Vascular Clinic of Semmelweis University and the Institute of Behavioural Sciences.
“Our aim is to see how well these are managed in a coordinated way. During the study, patients will receive additional support from care coordinators, who are nurses with advanced degrees. The care coordinator is in constant contact with the doctors involved in the treatment, ensuring better communication and providing direct support to help participants work through the problems arising from their illness,” says Zsuzsanna Bernáth-Lukács, president of the SZÍVSN National Patient Association. “It can be a problem, due to inadequate information exchange, that a heart patient with multiple chronic conditions visits several doctors’ outpatient clinics.
It is assumed that better communication between patients, relatives and doctors can improve patients’ health and thus their well-being. In this international project, we will monitor participants continuously for nine months, working with all the countries involved in the project. Our patients receive support from a care coordinator who is in constant contact with the doctors involved in their treatment, ensuring better communication and providing direct help to patients to get all the information they need and to work through the problems they are facing due to their illness,” says Zsuzsanna Bernáth-Lukács, President of the SZÍVSN National Patient Association.
There are about 150-200 thousand heart failure patients in Hungary, a significant number of them with several chronic diseases at the same time. These patients are usually treated by general practitioners and specialists. Scheduling appointments with doctors and administering therapies as prescribed can often be difficult. Patients are taking a number of medications prescribed by several doctors, who in many cases are not in contact with each other, so dangerous interactions can occur if patients take several different medications without coordinating them well. Thanks to a network of coordinators in several centres – Budapest, Miskolc, Szolnok, Dunaújváros, Szeged, Pécs, Gyula and Mátészalka – heart failure patients are also welcome to participate in the scientific study. As a consequence, patients will remain with their current treating physician who will designate them. Patients who are selected after completing a questionnaire will be able to meet their care coordinator after a short period of time. The consultations do not require a visit to the City Hall clinic, as they are held by telephone or online at an agreed time. We follow patients with heart failure for 9 months because we want to see the person behind the disease and provide personalised help as their family, lifestyle and circumstances allow. The combined work of the cardiologist, general practitioner, mental health professional, pharmacist and coordinator provides a solid basis for the development of informed care. Many people ask: how is this patient follow-up different, how is it new? Well, in order to make a significant difference, we need to know the patient’s cardiological status, access to treatment, living conditions. In the interviews, we learn about people’s fates, what they do in their daily lives, what is their relationship with family members, do they have hobbies? What medicines do they take, when and how do they measure their blood pressure and blood sugar?
What do they eat? Do they have help in everyday life, who do they share their questions with? What do they do when they feel very lonely? If they are aware of the symptoms of heart failure, they will initiate a new check-up sooner. Are they able to call an ambulance, have they worked out steps to get help quickly within the family? We give you the opportunity to connect to the online presentations of the national patient association Heart Failure, so you can meet other heart failure patients and feel that you are not alone.
We ask the doctors who treat them to help them to join this study, which has only been launched in Hungary at the Városmajori Clinic, as soon as possible.
Semmelweis University’s Citymajor Heart and Vascular Clinic and SZÍVSN, part of the international ESCAPE project, are inviting applications from people over 65 years of age with heart failure, mental stress and at least two other chronic diseases until mid-May. “This initiative is very important because on the one hand it gives us an idea of the burden that communication and lack of information can have on patients, and on the other hand it allows us to better connect the work of the patient organisation and the medical profession, and to better understand that we are working for more than one goal: to help patients and to make the healing work more effective,” adds the President.
