We have detected that you are using Internet Explorer to visit this website. Internet Explorer is now being phased out by Microsoft. As a result, NHS Digital no longer supports any version of Internet Explorer for our web-based products, as it involves considerable extra effort and expense, which cannot be justified from public funds. Some features on this site will not work. You should use a modern browser such as Edge, Chrome, Firefox, or Safari. If you have difficulty installing or accessing a different browser, contact your IT support team.
Publication, Part of National Heart Failure Audit
National Heart Failure Audit - 2008-09
Audit- Publication Date:
- 1 Oct 2009
- Geographic Coverage:
- United Kingdom
- Geographical Granularity:
- Country, Hospital Trusts
- Date Range:
- 01 Apr 2008 to 31 Mar 2009
Summary
This third report for the National Heart Failure Audit presents key findings and recommendations from the audit which was launched in July 2007. The data included in this report was submitted between April 2008 and March 2009. Aimed at healthcare professionals, managers and clinical governance leads, the report describes progress to date, clinical findings and patient outcomes, and implementation issues.
This report makes a number of recommendations to improve the data quality of the audit and the quality of heart failure care and treatment. The full list is given in the main body of this report, but some of the most important are highlighted as follows:
• All secondary care Trusts that treat patients with heart failure to participate in the audit
• As a move towards full participation, all secondary care Trusts to submit at least 50% of all cases of patients discharged with a diagnosis of heart failure in the primary position
• Strategic Health Authorities to require the inclusion of heart failure related Indicators for Quality Improvement in quality accounts
• All secondary care service providers to streamline the heart failure care pathway to ensure all patients, regardless of admission ward, have access to recommended medication in line with NICE guidelines and that treatment is managed by specialist staff
• Commissioners to use evidence of participation in the National Heart Failure Audit within the effective commissioning process to ensure that all patients with a confirmed diagnosis of heart failure have access to evidence based treatment as recommended by NICE.
Highlights
-
As of March 2009, 113 out of 166 (68%) Trusts had registered with the audit although only 71 (43%) were submitting data. This is an improvement from 2005-2006 when the Healthcare Commission found that only 20% of Trusts were collecting clinical audit data that meets the NSF criteria. Hospitals were asked to confine the survey to patients with a primary diagnosis of heart failure at the time of death or discharge from hospital. Hospitals submitted clinical data on 6170 patients in 2008-2009. Nationally this represents approximately 11% of patients discharged from hospital with a primary discharge diagnosis of heart failure and about 2% of all heart failure discharges
-
Patients with heart failure enrolled in this registry were mostly admitted under either cardiology (44%) or general medicine (46%). Echocardiography, a key investigation for heart failure, was done in more than 75% of cases. This is an improvement from 2007-2008 when only 32% of patients had access to this key diagnostic test.
-
The key treatments recommended by NICE include: ACE inhibitors, beta blockers, loop diuretic, aldosterone receptor antagonists (ARA). Prescribing these drugs in the right combination and dosage for each patient is a key element of the NSF and NICE guidelines. Audit findings suggest an improvement in the use of ACE inhibitors (80%) and beta blockers (46%) since the Healthcare Commission survey work in 2005-2006, when only 67% of patients were prescribed ACE inhibitors and 28% prescribed beta blockers. However, variation in access to the key clinical treatments reported by the Healthcare Commission continues. Patients admitted to cardiology were younger, more likely to be men, and more likely to be prescribed ACE inhibitors, beta blockers, loop diuretic, aldosterone receptor antagonists (ARA).
-
Mortality rates are high with 10.5% inpatient mortality and 30% mortality within the first year of discharge.
-
Patients admitted to cardiology had a significantly higher survival rate than those admitted to general medicine even after correction for differences in age, sex, symptoms and treatments. Patients with access to cardiology follow-up or heart failure liaison service also had higher survival rates than those who do not.
-
There is some indication that the number of core NICE drugs prescribed had a positive impact on survival and it is likely that the titration of key drugs had a further positive impact on mortality. Further exploration is required to determine the factors contributing to the improved survival rates for cardiology patients.
-
Of the patients who died, only 6% were referred to palliative care. Whilst this reflects the national picture of considerable unmet palliative needs for patients with heart failure, other factors may explain the low referral level. For example, challenges of determining end stage disease in heart failure patients or variations in referral patterns between different areas. In some cases patients may be discharged to primary care before referral to palliative care.
Resources
Last edited: 31 May 2022 4:53 pm