PANACEA-HF

New clinical trial empowers nurses to detect heart failure 

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Around one in ten Australians aged 60 years or over have undetected heart failure. In response to this problem, APNA has teamed up with researcher Professor Simon Stewart to run a clinical trial that uses cutting-edge AI technology. Practice Nurses to Augment the Clinical Evaluation and Care of People at High Risk of Heart Failure, or PANACEA-HF, aims to empower nurses to detect heart failure in its early stages and to prevent unnecessary hospitalisations. 

In a primary health care setting, the diagnosis of a chronic heart problem can take weeks. When a patient presents with certain symptoms, for example fatigue, shortness of breath, dizziness, swollen ankles, chest discomfort and/or nausea, their GP (depending on how they present) will likely refer them for a series of tests, which will involve several additional appointments. These tests usually include an electrocardiogram (ECG) and certain blood tests to establish a baseline. Another appointment will often be required to follow up on the test results and, depending on the overall picture of the results, more tests might be needed. All of these appointments will involve wait times that can contribute to a lengthy diagnostic process, and these wait times are likely to be longer in rural and remote areas. 

For someone living with, but not yet diagnosed with, heart failure, this prolonged timeframe can be disastrous. Rather than receiving the treatment they need from their GP, they might find themselves being rushed to an emergency room with a significant cardiac event. 

A world-first clinical trial hopes to cut down those weeks to just hours by empowering primary health care nurses to play a role in diagnosing heart failure in general practice using cutting-edge new technology. 

PANACEA-HF involves training nurses to use a portable AI-guided device to screen patients to detect heart failure in its early stages. Nurses then work in consultation with their multidisciplinary team and with their patients to determine the most appropriate treatment.  

Casey Kosch is a primary health care nurse who learned about PANACEA-HF through a colleague at Lister House Medical Clinic, where she works, in the regional Victorian town of Horsham. Casey had previously spent 20 years working in intensive care where she had witnessed firsthand the devastation that heart failure causes.  

‘I've seen patients getting to the end of their lives with heart failure,’ Casey says. ‘I had done the whole 360 and had seen them at the worst of the worst, and I thought, well, let's do something about that.’. 

What is PANACEA-HF? 

PANACEA-HF is a unique collaboration between APNA and Professor Simon Stewart, a health services researcher at the University of Notre Dame. 

‘Heart failure exerts a massive burden on the health system, and a late prognosis is worse than many forms of cancer,’ says Simon. ‘More than half a million Australians are walking around with a failing heart and the first time they know it, typically, is when they are hospitalised.’  

To gather evidence for an effective way to screen patients for heart failure before hospitalisation, Simon needed nurses to participate in a new model for a nurse-led coordinated care program.  

That's where APNA came in.  

‘Simon initially connected with us in February 2023 after reading about our Building Nurse Capacity program work,’ says Lisa Collison, General Manager of APNA's Research and Innovation unit. ‘He was seeking partnership for a grant application he was working on at that time. That initial grant was unsuccessful but gave us good insight into working as a team and what we needed to do to write a stronger proposal. We’ve now received funding from the Australian Government’s Medical Research Future Fund.’ 

‘We did this through a targeted approach, engaging with organisations and nurses who had taken part in the APNA Building Nurse Capacity (nurse clinic) program previously as we knew they had a good multidisciplinary team climate and the potential to succeed.’  

PANACEA-HF aims for a simple result: to develop a nurse-led coordinated care program using new AI-guided technology and point-of-care testing for early diagnosis of heart failure. The randomised control trial adheres to strict protocols. Patients who meet the selection criteria are invited to come for screening with participating nurses who use a point-of-care blood test, portable ECG and portable handheld echocardiography device to assess heart function. AI software is used to interpret the results of these tests. The patients are randomly divided into two groups: those who receive standard GP care and those who receive standard care that is enhanced by additional nurse-led holistic care, including home visits and patient education. The trial will compare health outcomes between the two groups to improve care for future patients. 

Casey’s participation in PANACEA-HF 

PANACEA-HF appealed to Casey because it offered a chance for her to be a part of an innovative study, to support prevention and management of heart failure in her local community, to improve access to point-of-care testing and to learn how to use a portable echocardiogram (cardiac ultrasound machine). 

‘Learning how to do echoes was just...wow!’ says Casey. ‘Our patients don't have access to the basic echoes as they should. Even when we have acute patients come in, we only have echo at the hospital on Thursday and Friday every second week.’  

Casey underwent extensive training sessions with the portable echo and learned how to get accurate readings from the new AI-guided software. She says it took a few months to get comfortable with the machine.  

‘At first, we had trainers who were cardiologists, but what we needed were ultrasound techs. We needed the basics!’ she explains. 

Fortunately, Casey and the other nurses involved were regularly in touch with Simon, who was able to adapt the training to suit the needs of all nurse participants. She says she was about four months into training when she finally felt confident and comfortable with the equipment and began to see success stories in the making. 

‘I had a guy come in a couple of weeks ago,’ she says. ‘He's a very fit man and we performed an echocardiogram on him.’ 

It turned out the patient had undetected heart failure. 

‘We're calling him and bringing him back in. Hopefully, fingers crossed, we've picked this up nice and early. He would never have gone and had an echo otherwise.’  

Moments like these allow Casey to see a hopeful future for her clinic. 

‘There's a six-month wait for our patients to have an echocardiogram here. It would be amazing if we could pick this stuff up nice and early for our patients.’ 

Showcasing PANACEA-HF 

In November 2024, one of the project’s lead nurses, registered nurse Kym Evans from Springs Medical, attended a Parliamentary Friends of Nursing event in Canberra. Kym demonstrated the convenience of the portable handheld echocardiogram device on politicians and staffers who volunteered.  

‘We were able to show politicians and their staffers just how highly skilled primary health care nurses are and what they can achieve given the opportunity,’ says Lisa. 

PANACEA-HF now has ten nurse participants taking part, working in general practices around Australia. The project will run for four years and is scheduled to end in February 2028. The results of the study will identify efficient and cost-effective ways to: 

• Empower nurses to provide proactive care 

• Increase access to preventative care 

• Improve affordability of services 

• Reduce pressure on the health care system 

• Prevent hospitalisation and premature mortality in patients with heart failure.  

All of this, combined with reduced wait times for patients, will mean happier and healthier hearts for millions of Australians. 

Left to right: Kym Evans (PANACEA HF lead registered nurse), Professor Simon Stewart, Dr Mike Freelander, MP, and Lisa Collison (General Manager of APNA's Research and Innovation unit) at the Parliamentary Friends of Nursing event in Canberra.