Audit Highlights Need For More Information About Care Of NHS Heart Failure Patients, UK

Main Category: Cardiovascular / Cardiology
Also Included In: Heart Disease;  Public Health
Article Date: 14 Oct 2008 - 1:00 PDT

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The first ever National Heart Failure Audit today highlights the need for more NHS hospital trusts to submit information about patient care.

As of March 2008, 105 of 147 trusts providing services had registered with the audit, which is commissioned by the Healthcare Quality Improvement Partnership and run jointly by The NHS Information Centre and the British Society for Heart Failure.

But only a quarter of trusts (37) submitted data about cases of heart failure - which affects at least one in every 100 people in the UK and is predicted to affect even more people in the future due to an aging population.

Good participation levels and data submissions among trusts are vital; to measure progress towards meeting national guidance and standards, to support standards of care, support patient choice and to help effective commissioning.

The audit received anonymised data from only 6,299 cases - approximately six per cent of all cases of patients discharged from hospital with a diagnosis of heart failure.

As data submission was limited, early findings cannot be seen as conclusive, but do appear to reinforce previous studies into heart failure.

Early findings include:

-- Just under a third (31 per cent) of patients were treated on cardiology wards. The majority (61 per cent) were treated in general medicine wards and 7.9 per cent were treated on other wards.

-- The majority of patients received at least one of the five key drug therapies for heart failure. Four per cent (215) did not receive any. These were mostly patients between the age of 75 and 84 treated within general medicine.

-- Electrocardiogram (ECG) was recorded in nearly 35 per cent (2,173) of cases, while echocardiography results were recorded in 32 per cent of cases (2,014). NICE (The National Institute for Clinical Excellence) and NSF (National Service Framework for Coronary Heart Disease) guidelines emphasise the importance of having a confirmed diagnosis of heart failure, which can be done via ECG, as many symptoms are similar to those of other conditions such as asthma.

Among its recommendations, the audit identified a need for the NHS Information Centre to work with partner organisations to identify ways of supporting local implementation of the audit, and of using audit findings to support local improvements of heart failure services.

NHS Information Centre chief executive Tim Straughan said: "At least one person in every hundred coming through the door of an NHS hospital has heart failure, and clearly the treatment of this condition has huge implications for patients, staff and the NHS as a whole.

"The National Heart Failure Audit is therefore essential in providing The NHS with a comprehensive picture of heart failure treatment and outcomes, and in helping to improve patient care. I welcome the input from hospital trusts that submitted data to this vital audit, and urge other trusts to do so in the future."

Click here to see the full report.

-- The NHS Information Centre is England's authoritative, independent source of health and social care information. It works with more than 300 health and social care providers nationwide to provide the facts and figures that help the NHS and social services run effectively. Its role is to collect data, analyse it and convert it into useful information which helps providers improve their services and supports academics, researchers, regulators and policymakers in their work. The NHS Information Centre also produces a wide range of statistical publications each year across a number of areas including: primary care, health and lifestyles, screening, hospital care, population and geography, social care and workforce and pay statistics.

-- This report summarises key findings from the first eight months of the national roll out of the audit between July 2007 and March 2008.

-- Previous studies into heart failure, which appear to support early findings from the audit, are included in section 7 (references) of the report.

-- The five key drugs for heart failure are:

- ACE inhibitors, which have a protective effect on the heart and when added to diuretics, improve symptoms, exercise tolerance, and survival and reduce hospital admission rates in chronic heart failure.

- Beta-adrenoreceptor blocking drugs (beta-blockers) , which work on the heart and blood vessels to reduce blood pressure and the amount of work the heart does. A beta-blocker is usually prescribed in addition to an ACE inhibitor.

- Angiotensin-II receptor antagonists (ARB) work in a similar way to ACE inhibitors and are used instead of an ACE inhibitor if a patient has problems or side-effects with taking an ACE inhibitor (such as a persistent cough).

- Loop diuretics, which are commonly needed to ease fluid retention. Diuretics are taken in addition to an ACE inhibitor and beta-blocker.

- One receptor antagonists (SARA) . The aldosterone antagonist sprionolactone has been shown to reduce mortality in patients with severe heart failure.

http://www.ic.nhs.uk.