National Heart Failure Audit - 2008-09

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.