Are we meeting the guidelines? : a review on management of heart failure patients in a general hospital in UK

Background

Heart Failure (HF) is a major health concern which carries very high mortality & morbidity despite therapeutic advances. It is a significant burden on healthcare systems worldwide. Guidelines of best practices have been implemented, to conquer these challenges. It is a much-needed practice to periodically assess how much we are adherent to the recommendations, in order to deliver the best patient care.

Purpose

Patients who were primarily diagnosed with new HF at Cardiology Unit in a General Hospital in United Kingdom were assessed, with the objective of evaluating how much adherent to the recommended guidelines in practical settings. Whenever the therapeutic measures are not achieving the targets, the reasons were also looked for. Additionally, the demographic profile, the aetiology of HF and average duration of hospital stay were also assessed.

Method

Data was collected retrospectively from the case notes of patients who were discharged with a diagnosis of new heart failure with reduced ejection fraction (HFrEF) from October 2023 to June 2024. Patients with previously known HFrEF were not included. A total of 50 patients who fulfilled the inclusion criteria were selected .

Results

Majority were males and between 75-84 years in age. 86% had nT pro BNP testing & 100% had inpatient echo in diagnostic work up. Arrhythmias and ischemic heart disease were the two leading causes of new HF. Patients were receiving beta blockers, angiotensin converting enzyme (ACE) inhibitors/ Angiotensin Receptor Blockers (ARBs), SGLT2 inhibitors and Mineralocorticoid Receptor Antagonists (MRA) at 90%, 70%, 70% and 60% respectively.

Asthma/COPD was the main reason when beta blockers were not prescribed. Low blood pressure was the main reason not to prescribe ACEI/ARB. MRA was mostly not prescribed due to low BP, renal impairment or hyperkalaemia, but the reason was unclear among 38%. When SGLT2 inhibitor was not prescribed, the reason was uncertain among most.

In addition to 4 prognostic medications, 86%, 22% and 6% had received loop diuretics, Digoxin and Ivabradine respectively.

The average hospital stay was between 5-10 days and all patients were seen by HF team as inpatients. 86% were arranged cardiology clinic follow up where as all were due for follow up with community HF team.

Conclusions

Therapeutic management of HFrEF is still sub optimal, even with a robust healthcare system and yet to meet the national targets.

Out of the 4 prognostic medications, only Beta blockers had been prescribed to a satisfactory level, reaching national targets. Other 3 medications; namely ACEI/ARB, MRA and SGLT2 inhibitor were prescribed to a reasonable level, yet there is more space to improve in prescribing.

A commendable service is delivered by both hospital and community heart failure teams in patient management. Further awareness programmes on standard diagnostic & therapeutic strategies are needed, in order to improve care.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.