Q&A with Dr Rajiv Sankaranarayanan
Virtual Wards for Heart Failure: Q&A with Dr Rajiv Sankaranarayanan, Consultant Cardiologist at Liverpool University Hospitals
Dr Rajiv Sankaranarayanan, Consultant Heart Failure Cardiologist at Liverpool University Hospitals NHS Foundation Trust (LUHFT), HF Lead at Cheshire and Merseyside ICB and NHS England National GIRFT Clinical Lead for Virtual Wards, is at the forefront of innovation in heart failure management. His pioneering work on the Liverpool Acute Heart Failure Virtual Ward has garnered significant recognition, including an HSJ Patient Safety Award, coverage on the BBC, a health ministerial visit, nomination at the Health Innovation Network Awards and an invited presentation at the European Society of Cardiology Annual Conference.
As he prepares to share his insights at Digital Health Rewired, we spoke to Dr Sankaranarayanan to discuss how remote monitoring is transforming the management of acute heart failure and also reshaping chronic care delivery.
Why did you develop the Heart Failure Virtual Ward at LUHFT?
The inspiration came from seeing the pressure on hospital beds, on clinicians and most importantly on patients and the need for a solution that would not only ease this burden but also improve patient outcomes. Heart failure is a chronic condition that often requires frequent hospitalisations due to acute presentation (new diagnosis or known), and we wanted to find a way to address this more proactively.
It’s also about empowering patients. Many patients want to take a more active role in managing their condition, and remote monitoring is the perfect tool to support them. By providing remote monitoring and timely interventions, we can help patients manage their conditions at home more effectively and reduce the likelihood of further acute episodes.
Can you explain how the Heart Failure Virtual Ward works?
Our Virtual Ward enables a specialist multidisciplinary team to monitor patients in real-time and enables us to collect critical metrics like daily ECGs, blood pressure, pulse, weight, step count, oxygen levels and portable echocardiograms (using AI when indicated). These measurements are taken remotely, often from devices that patients use in the comfort of their own homes. Information obtained from this data is combined with home intravenous diuretics using an elastomeric pump, point of care blood tests and face to face home visits by HF specialist nurse (scheduled and rapid response). We also perform rapid treatment optimisation being one of three sites in the UK and one of 10 in the world taking part in the STRONG-HF pilot. Following the acute HF Virtual Ward stay, patients are onboarded to receive home digital cardiac rehab via KiActiv (a world first in this model of care). We also discuss their care in a multi-morbidity MDT meeting with other specialists
What are the key benefits of the virtual ward for patients and healthcare providers?
For patients, the benefits are transformative. We’re seeing a significant reduction in hospital admissions and readmissions, which means fewer disruptions to patient lives. Even when hospital stays are necessary, they tend to be shorter because patients are more stable when they arrive. Perhaps most importantly, patients report feeling more in control of their condition and enjoy an improved quality of life. Importantly, this model of care enables acute HF patients to be directly managed by HF specialists so they can receive the best possible care in their home surroundings and with their family.
By reducing pressure on hospital resources, we can focus on providing more personalised care. Early interventions help us prevent complications, which is not only better for patients but also more efficient for the system, while the data we gather allows us to continuously refine and improve care plans.
What challenges did you face during implementation and how did you overcome them?
Like any innovation, the Virtual Ward wasn’t without its challenges. Integrating the telehealth platform into existing workflows requires effort, while clinicians needed to trust the technology and feel confident in using it, and this can take time. We also needed to enable new ways of working, whereby hospital staff seamlessly started to work in the community doing home visits, but also learnt to use new technology such as point of care blood tests.
What do you see as the future potential for virtual care in managing chronic conditions?
The future for virtual care in managing acute conditions incredibly exciting. I see virtual wards expanding to include other acute conditions exacerbation of COPD, ARI, frailty syndromes and other acute medical conditions. These are areas where remote monitoring can have a huge impact to help ease the pressure in A&E and bed pressures in hospital wards.
Technology will also continue to evolve. Wearable devices, for instance, will allow for even more personalised and continuous monitoring. The integration of AI into these systems will help us predict and prevent problems before they even arise.
Ultimately, I think virtual care will become a cornerstone of healthcare delivery. It’s not just about reducing hospital dependency—it’s about empowering patients, treating their condition in their homes with a specialist multidisciplinary team using the latest technology and enabling them to live healthier, more independent lives.
Thank you!
Dr Rajiv Sankaranarayanan’s work on the Heart Failure Virtual Ward demonstrates the transformative potential of telehealth in acute care management. By blending technology with patient-centred care, he is paving the way for a more proactive and effective approach to healthcare.
If you want to find out more, make sure you attend Dr Sankaranarayanan’s session.
