Best practice in the region: Using TriageHF™ to support earlier intervention for people living with heart failure

Norfolk and Norwich University Hospital’s Heart Failure Specialist Nurse team is using remote monitoring technology to identify patients at risk of heart failure deterioration – creating opportunities for earlier intervention and potentially avoiding hospital admissions.

In the UK, around 920,000 people are living with heart failure, with approximately 200,000 new diagnoses made each year (1).  Heart failure remains a leading cause of unscheduled hospital admission and places a significant burden on patients and NHS services (2).

Episodes of worsening heart failure often result in emergency hospital admissions, which can be frightening and disruptive for patients as well as costly for the healthcare system. Recognising early signs of deterioration and intervening promptly can create an opportunity to stabilise a patient’s condition before symptoms become severe enough to require hospital treatment.

At Norfolk and Norwich University Hospital (NNUH), the Heart Failure Specialist Nurse (HFSN) team is using TriageHF™ technology to help make this possible.

Introducing TriageHF™ at Norfolk and Norwich University Hospital

In May 2025, the HFSN team at NNUH implemented TriageHF™ to identify patients at increased risk of heart failure decompensation and supporting earlier clinical management. Utilising the high, medium or low risk stratification alert system of TriageHF™, the team aimed to reduce hospital admissions and improve clinical management while enhancing the patient’s quality of life.

For the HFSN team, implementation has also created an opportunity to take greater ownership of patients within the heart failure cohort and establish a more proactive relationship with people who may otherwise only come into contact with the specialist team when they are already unwell.

A telephone consultation following a TriageHF™ alert may be the first time a patient has spoken directly with a Heart Failure Specialist Nurse.

This provides an important opportunity not only to assess symptoms and review medication, but also to introduce the specialist nursing service, explain how patients can access support and provide contact details for future concerns.

Over time, this relationship-building could prove an important part of supporting patients to recognise deterioration earlier and seek appropriate help before their condition escalates.

Learning from other NHS teams

Before introducing TriageHF™ at NNUH, the HFSN team connected with a representative from Birmingham and Solihull Integrated Care Board to understand their experience of implementation at Sandwell and West Birmingham Hospitals NHS Trust.

Sharing practical learning from an established service enabled the NNUH team to anticipate potential challenges, avoid common pitfalls and develop an approach suited to the local context.

The experience at NNUH has also generated interest across the wider Norfolk and Suffolk system, with the potential to extend TriageHF™ to other trusts in the region. Proposed expansion includes James Paget University Hospitals NHS Foundation Trust and The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust.

By sharing learning across organisational boundaries, teams can build on existing expertise rather than duplicating work, helping to accelerate the adoption of approaches that have demonstrated value.

A patient case: acting before deterioration becomes an admission

The potential impact of TriageHF™ can be seen in the experience of one patient following a hospital admission for cellulitis.

After discharge, the patient had stopped taking his prescribed diuretic. A high-risk TriageHF™ alert was subsequently generated, indicating an increased risk of heart failure decompensation.

When contacted by the HFSN team, the patient reported that he was more breathless and had gained 3kg in weight – both potential indicators of worsening heart failure and fluid retention.

The patient explained that he had stopped taking his diuretic because, during his hospital admission, he had been told that the diuretic he was taking can affect the kidneys. This had understandably raised concerns about continuing the medication.

The HFSN was able to use the telephone consultation to explore the patient’s concerns, provide education about heart failure symptom management and explain the role of diuretics in managing fluid retention.

Following the discussion, the patient agreed to restart his prescribed medication.

When the HFSN team followed up one week later, the patient reported that he was feeling better. He was less breathless and his weight was beginning to reduce.

The patient was subsequently booked into the HFSN clinic for medication optimisation and symptom review and will continue to be monitored through TriageHF™.

This case demonstrates the potential value of combining remote monitoring with timely, person-centred clinical assessment. The technology identified a potential deterioration, but it was the subsequent conversation with a specialist nurse that enabled the underlying issue to be identified and addressed.

From technology to a new model of care

The value of TriageHF™ is not simply in generating an alert. Its potential lies in what happens after the alert.

At NNUH, the technology forms part of a wider clinical pathway in which risk information prompts contact with the patient, assessment of symptoms, exploration of potential causes and appropriate intervention.

This supports a more proactive approach to heart failure management. For patients, this can mean earlier access to specialist advice and treatment, potentially preventing deterioration from progressing to a level that requires emergency care.

For clinicians, it provides a structured way of identifying patients who may need attention, helping the HFSN team focus their expertise where it is most needed.

And for the wider health system, it offers the potential to support admission avoidance, improve coordination of care and make better use of specialist resources.

Sharing learning across the East of England

The experience at NNUH demonstrates how a locally implemented innovation can create opportunities for wider regional learning.

Following the initial success at NNUH, other hospital trusts across the East of England are exploring the potential implementation of TriageHF™.

Scaling this approach could support greater consistency in the way patients with compatible CIEDs and heart failure are monitored, while creating opportunities for teams to share knowledge, develop clinical expertise and learn from one another.

The TriageHF™ care team is working collaboratively with the East of England Cardiac Network and Health Innovation East to understand how learning from NNUH can be disseminated more widely and to explore opportunities for further adoption and spread across the region. There is also growing national interest in the adoption and spread of TriageHF, with the national Health Innovation Network exploring opportunities to support wider implementation beyond the East of England due to its potential to identify worsening heart failure earlier and reduce avoidable hospital admissions.

Looking ahead

The next stage is to build on the learning from NNUH and understand how TriageHF™ can be effectively implemented at scale.

This will include sharing practical learning with other trusts, supporting teams as they develop local pathways and continuing to understand how remote monitoring can complement personalised clinical care.

For people living with heart failure, earlier identification of deterioration can mean the difference between receiving timely support at home and requiring emergency hospital treatment.

The experience at NNUH shows how combining remote monitoring, specialist nursing expertise and cross-organisational learning can help make earlier intervention a reality.