Care improving for people with heart failure, says report

21 October 2009: People with heart failure are being better diagnosed and treated than they were three years ago, says a report out today.

However, the National Heart Failure Audit annual report shows that sharp differences in the quality of care patients receive continue to exist, with access to the key therapies recommended by the National Institute for Health and Clinical Excellence frequently dependent on the type of ward to which patients are admitted.

The study covers the period between April 2008 and March 2009 and was jointly run by The NHS Information Centre and the British Society for Heart Failure and funded by the Healthcare Quality Improvement Partnership (HQIP).

Its purpose is to support better care by measuring the quality of care and clinical outcomes of all patients who have been discharged with a diagnosis of heart failure. The audit builds on earlier work carried out by the former Healthcare Commission in 2005/06.

There is a significant improvement in the number of Trusts meeting the clinical audit standards set out in the National Service Framework for CHD. In 2005/06, only 20 per cent of NHS Trusts were able to meet the criteria for auditing their services. As of March 2009, 113 out of 166 trusts (68 per cent) were registered with the audit, with 71 (43 per cent) submitting data.

On diagnostics, the report shows 75 per cent of patients had echocardiography - a key investigation for heart failure - in 2008/09, compared with only 32 per cent in 2007/08.

For the two NICE-recommended key treatments for which comparative data is available, access had improved so that:

• 80 per cent of patients were given ACE inhibitors in 2008/09, compared to 67 per cent in 2005/06
• 46 per cent were given beta blockers in 2008/09, compared to 28 per cent in 2005/06

However, despite this improvement, the report showed 12 per cent of patients did not receive any of the five key treatments which also include loop diuretics, aldosterone receptor antagonists (ARA) and angiotensin II receptor antagonists (ARB)

Nevertheless, in-hospital mortality fell to 10.5 per cent in 2008/09 compared to 15 per cent in 2005/06. The audit showed numbers of patients dying within one year of discharge is 30 per cent.

Despite overall improvements in the quality of diagnosis and care, the report highlighted considerable variation in care and outcomes depending on whether the patient was admitted to a cardiac or general medicine ward.

The outcome for patients admitted to a cardiology ward were significantly better than those admitted to general medicine even after correction for differences such as age, sex, symptoms and treatment.

Patients on a cardiology ward were more likely to be on one of the five key treatments than if they were cared for elsewhere in hospital. They were also more likely to survive, with mortality rates in cardiology wards of 22 per cent , compared to 36 per cent on a general medicine or 41 per cent on other wards.

For end of life care, of patients who died only six per cent were referred to palliative care and likely to reflect the national picture of unmet palliative needs for patients with heart failure.

The NHS Information Centre's chief executive Tim Straughan said: "While it is encouraging to see that the NHS is making significant strides in improving quality of care and outcomes, there is still much to be done.

"Trusts should prioritise participating in this annual piece of work which plays an invaluable role in providing comparative data which can help them scrutinise their service and deliver tangible improvements.

"A key issue for all trusts must be the access their patients get to the key treatments recommended by NICE which are proven to make a real difference to outcomes. The fact that access to these treatments is so variable must be a cause of concern and will no doubt be an issue that clinicians and managers will need to focus on in the weeks and months to come."

Robin Burgess, Chief Executive of the Healthcare Quality Improvement Partnership (HQIP) said: "This audit shows that considerable progress is being made in this vital area of care. It is pleasing to see how clinical audit strongly forms part of quality improvement, whereby local services supply data for analysis and then local improvements are made. Through clinical audit, services are encouraged to improve and they do. There is more to be done, but these results are very encouraging for those with heart problems of this type."

The full audit report can be accessed here.

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