Audit of a tertiary heart failure outpatient service to assess compliance with NICE guidelines.

Guha, Kaushik; Allen, Christopher J.; Chawla, Sumir; Pryse-Hawkins, Hayley; Fallon, Laura; Chambers, Vicki; Vazir, Ali; Lyon, Alex R.; Cowie, Martin R.; Sharma, Rakesh

The National Institute for Health and Care Excellence (NICE) updated its guidelines for chronic heart failure (HF) in 2010. This re-audit assessed interim improvement as compared with an audit in 2011. Patients with H F (preserved and reduced ejection fraction) attending a tertiary cardiac centre over a 2-year period (January 2013-December 2014) were audited. The data collected included demographics, H F aetiology, medications, clinical parameters and cardiac rehabilitation. In total, 513 patients were audited. Compared with 2011, male preponderance (71%) and age (68±14 years, (Mean ± SD)) were similar. 73% of patients lived outside of London. HF aetiologies included ischaemic heart disease (37% versus 40% in 2011), dilated cardiomyopathy (26% versus 20%) primary valve disease (13% versus 12%). For patients with left ventricular systolic dysfunction (n=434, 85% of patients audited) 89% were taking beta-blockers (compared with 77% in 2011), 91% an angiotensin converting enzyme inhibitor or angiotensin receptor blocker (86% in 2011) and 56% a mineralocorticoid receptor antagonist (44% in 2011); 6% were prescribed ivabradine. All patients were reviewed at least 6-monthly. Although 100% of patients were educated about exercise, only 21 (4%) enrolled in a supervised exercise programme. This audit demonstrated high rates of documentation, follow-up and compliance with guideline-based medical therapies. A consistent finding was poor access to cardiac rehabilitation.

ENGLAND; OUTPATIENT medical care; AUDITING; HEALTH care teams; CARDIAC rehabilitation; HEART failure; MEDICAL protocols; NATIONAL health services; SCIENTIFIC observation; REGULATORY approval; EDUCATIONAL outcomes; RETROSPECTIVE studies

Clinical Medicine, 2016, Vol 16, Issue 5, p407

1470-2118

Academic Journal

10.7861/clinmedicine.16-5-407