How Northern Ireland compares to national UK standards in inpatient heart failure management
O Graham, N Melarkey, R Kennedy, S Zuhairy, M Melody, P CampbellAbstract
Introduction
Heart Failure (HF) poses a substantial challenge to global public health with over 64 million people affected. It is not only imperative that we seek to reduce HF disease burden to mitigate the financial costs incurred but in addition, do so in order to transform patient outcomes. As such, the adoption of evidence-based management of HF into our everyday clinical practice is vital. The 2024 National Heart Failure Audit (NHFA) seeks to enhance quality improvement for both the care and outcomes of patients living with HF. Recommendations within the NHFA include targets relating to echocardiogram, care under cardiology and Heart Failure Nurse Specialist (HFNS).
Aim
To evaluate our current practice with regards to the care of HF patients during an inpatient admission and subsequent follow up. Allowing direct comparisons between our current practices with NHFA recommendations.
Methods
A retrospective study was conducted involving two hospitals within one trust in Northern Ireland (NI). We evaluated patients with a diagnosis of new HF or decompensation of known HF who were discharged between September 2022 and August 2023. The use of electronic care records allowed the collection of data about discharging specialty, TTE, HFN input as both inpatient and outpatient, mortality along with HF readmission at 1 year.
Results
313 patients included in this study of which 36.4% (114 patients) had a new diagnosis of HF versus 63.6% (199 patients) with decompensation of known HF. 21.7% (68 patients) admitted under cardiology versus 78.6% (246 patients) admitted under general medicine. The target set by the NHFA is that 60% of HF patients should be admitted under cardiology. 3.8% (12 patients) underwent an inpatient HFNS review compared with the target of 100%. NHFA outlines that 100% patients should have an outpatient HFNS review which should occur within 14 days. 56% patients (158) were reviewed in outpatients by the HFNs. Within the Southern Trust, 6.7% (19 patients) were reviewed in outpatients by HFNS within 14 days. In terms of TTE, 67.4% (211 patients) underwent inpatient TTE compared with 90% advised by NHFA. 28.1% (88 patients) underwent TTE within the year prior to admission. Overall, 95.5% (299 patients) all had a TTE either during admission or within the previous year. 9.9% (31 patients) died during inpatient admission. Of the 90.1% (282) patients discharged alive, 30.9% (87) patients were readmitted with HF decompensation within one year.
Conclusion
Our review highlights gaps in inpatient HF care and subsequent follow up. Recognition of these areas of need is the first step in seeking to identify what challenges preclude the integration of a more equitable quality of care for HF patients. Certainly, the expansion of the HF nurse led service including establishment of a dedicated inpatient HF service has the potential to significantly enhance the care of HF patients.