Driving early detection: a community-based approach to heart failure screening

Horizon Fellow: Angela Murphy

Role: Service Lead Heart Failure Nurse Manager
Organisation: Chelsea and Westminster NHS Foundation Trust

Outreach Heart Failure Project

Summary: Offering point-of-care screening for underlying heart failure in a community roaming clinic for communities in Hounslow.

Story of the project

Despite advances in heart failure therapy over recent years, admissions to hospital remain high. These patients are often some of the most vulnerable in our community and may have experienced symptoms for months or even years.

We know 80% of people diagnosed with heart failure receive their diagnosis on an inpatient admission, often requiring a lengthy hospital stay with high rates of readmission. For this reason, we wanted to target people with a greater risk of developing heart failure and screen them in the community to determine if they have an elevated biomarker indicating underlying heart failure.

Leading a small team of community specialist nurses, we are fortunate to have fantastic relationships with both our primary and secondary care colleagues. We felt an integrated approach to finding solutions would benefit patients most and harnessing successful services already in place in the community made sense.

We successfully applied for some funding from NHS England in January 2024, but progress was slow due to multiple complexities. Launched in June 2025 with support from the Horizon Fellowship and key stakeholder collaboration, the project is set to run for one year.

Key aims for the project include:

• testing whether this approach successfully identifies patients in Hounslow with a heart failure diagnosis; and
• start evidence-based therapies in a timely manner, thereby reducing patients’ risk of a decline in their health and potentially reducing hospital admissions.

Outcomes

We partnered with an existing successful service in primary care called the Healthy Hounslow service. They offer roaming screening clinics in a converted ambulance and particularly target areas with higher deprivation and inequalities. This team were excited to join the project and enhance their services.

Key impact measures will be:

• patient uptake;
• numbers identified with elevated biomarker;
• numbers of patients receiving a diagnosis of heart failure;
• number of patients admitted to hospital; and
• patient and staff experience.

These measures will inform:

• whether patients in Hounslow are more likely to accept an offer of screening that is more agile and convenient to them. Hounslow ranks among the areas with the greatest loss of life before age 75 due to heart-related conditions nationally as well as high rates of heart failure hospitalisations.
• whether we can successfully identify underlying heart failure and start treatment earlier
• the cost benefit to healthcare systems in doing so

Advancing the project through Horizon Fellowship collaboration

Previous experience with innovation projects had piqued my interest in joining the Horizon Fellowship, as I have seen the real impact these projects can make. I wanted to continue to develop our services and consider smarter approaches to delivering care, especially in the current climate where all departments and resources are limited.

The Horizon Fellowship enables people across the organisation and beyond to share their experience and advice, and support you in your efforts. Being part of the Fellowship has been especially useful for moving the project forward, especially when progress slows and motivation wanes.

Joining the Horizon Fellowship has been invaluable, not only in my work towards the project but in my day-to-day practice.

The insights and advice I have received from the Horizon Fellowship team, subject matter experts and peers allowed me to troubleshoot issues that were stalling the project. I could also network and make connections that will benefit me beyond my time on this course.

It also proved to me that my experiences and knowledge holds value for others, as interactions with peers on the programme, such as during the pitching workshop and group break out sessions, has assisted them with their own projects. We are more likely to be successful as a collective rather than in isolation.

Next steps

Should the project show benefit, the evidence will support a business case to continue with the service and roll out to the entire Hounslow borough. We also plan to gather our evidence and share our learnings so similar initiatives can be replicated in other areas.

It potentially will add evidence to smarter screening of data captured on GP registers and identifying appropriate patients for screening for other long term health conditions.

For more information on the Horizon Fellowship, which has since been rebranded as the CW Innovation Fellowship, visit the CW+ website. You can also check out our Innovation Directory to browse through the full list of Fellows.