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Audited mortality rates for patients with acute heart failure - both in hospital and following discharge - fell for the first time, according to the sixth annual National Heart Failure Audit report.
For patients admitted to hospital in the UK with acute heart failure. In-hospital mortality rates dropped from 11.1% to 9.4%: a 15.3% relative reduction. For patients who survived to discharge there was also an improvement in outcomes: 24.6% of patients discharged in 2012/13 died during the year, compared to 26.2% last year. This is despite a patient group with similar characteristic across the two years.
These improvements indicate the success of the audit in driving up standards of care. "This is good news for people with heart failure and their families" said Theresa McDonagh, clinical lead for the National Heart Failure Audit and Consultant Cardiologist and Professor of Heart Failure at King's College Hospital:
"For the first time, the National Heart Failure audit has reported a reduction in both in-hospital and post-discharge mortality for patients admitted to hospital with heart failure in England and Wales. This appears best explained by an increase in the number of patients receiving specialist care, which increases their chances of receiving the recommended medications and being referred for specialist follow-up care. Prescription rates of key evidence-based medicines have also risen."
The National Heart Failure Audit is managed by NICOR (National Institute for Cardiovascular Outcomes Research) and supported by the British Society of Heart Failure (BSH). It is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP), which is funded by NHS England.
Despite this evident progress, the report shows that there is wide variation in care depending on ward of treatment, and also between hospitals. This year's audit, which collected data on 43,894 heart failure admissions between 1 April 2012 and 31 March 2013, supports findings from previous years, highlighting the urgent need for more patients who are admitted to hospital with heart failure to receive specialist care, preferably on a cardiology ward.
If a patient is treated on a cardiology ward the likelihood of survival to discharge is far greater than if a patient is admitted to other wards - in 2012/13 only 7.0% died if admitted to a cardiology ward compared to 11.3% on general medical wards and 14.4% on other wards.
When analyses were adjusted for age and severity of disease, the added benefit of being treated on a cardiology ward remained. Patients not treated on a cardiology ward are 54% more likely to die in hospital than their cardiology counterparts. For all patients who survived to discharge in 2012/13, those not treated on a cardiology ward were 14% more likely to die within the audit year, when confounding factors are taken into account.
Only half of all patients included in the 2012/13 audit were treated on cardiology wards, although 78% were seen by a nurse or doctor with a heart failure specialism.
The use of recommended medications (such as beta blockers and ACE inhibitors) is strongly associated with improved outcomes, and patients are far more likely to receive these drugs if they are treated by heart failure specialists. Although prescription rates of recommended treatments are increasing, there is still a substantial group of patients who do not receive them.
Referral to specialist cardiology and heart failure follow-up services on discharge is also associated with lower rates of death for heart failure patients. Over half of patients in the audit were referred to follow-up with a cardiologist or heart failure nurse. Patients treated on a cardiology ward were, again, far more likely to be referred to these specialist follow-up services.
Professor Huon Gray, National Clinical Director (Cardiac) at NHS England said: "More patients are being cared for within specialist cardiac care or cardiology wards, more patients are receiving specialist input overall, and improved prescribing rates of disease modifying drugs are seen. This is encouraging but there remains much that can be done to ensure all patients receive an early diagnosis and care from a specialist cardiology team. When patients leave hospital they can be especially vulnerable and early careful review from within the multidisciplinary team will help drive better outcomes."
The National Heart Failure Audit monitors the treatment and care of people with an unscheduled admission to hospital who are discharged with a primary diagnosis of heart failure. Heart failure affects an estimated 900,000 people in the UK, and accounts for around 5% of all emergency admissions to hospital.
Professor Andrew Clark, Chair of the British Society for Heart Failure, said: "The publication of the annual audit is one of the highlights of the year for professionals looking after patients with heart failure. It becomes ever more useful, particularly as hospital-level data become available. It is a major tool for improving quality of care for our patients, and it is exciting to see those improvements being reflected in falls in mortality rates both in hospital and after discharge."
The full report can be found here.
www.ucl.ac.uk/nicor/ (National Institute for Cardiovascular Outcomes Research)
Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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9 Mar. 2014. <http://www.medicalnewstoday.com/releases/269106>
NICOR, . (2013, November 21). "National Heart Failure Audit 2012/13: Audited patient mortality rates fall for the first time, UK." Medical News Today. Retrieved from
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