NHS Heart Failure Survey - a survey of acute heart failure admissions in England, Wales and Northern Ireland

Edward D Nicol ^1*, Barbara Fittal ¹, Michael Roughton ², John G F Cleland ², Henry J Dargie ² and Martin R Cowie ²

¹ Healthcare Commission, United Kingdom
² British Society for Heart Failure, United Kingdom

^* To whom correspondence should be addressed. E-mail: cyprusdoc{at}doctors.org.uk.

Accepted 11 September 2007

Abstract

Objectives To obtain national data on demographics, investigation, treatment and short-term outcome for patients admitted with acute heart failure in England, Wales and Northern Ireland.

Design Retrospective survey of emergency admissions with acute heart failure (discharge code I50) from October 2005 to March 2006.

Setting Acute NHS trusts in England, Wales and Northern Ireland.

Main outcome measures Patient demographics, referral source, admission characteristics, admission pathway, patient heart failure treatment on admission, length of stay, short-term mortality, discharge heart failure treatment, specialist follow-up and delayed discharge.

Results 176/177 (99%) acute trusts responded and 9,387 records were surveyed. Patients mean was age 77(SD 11, range 24-105) years, 50% were women and 56% had prior history of heart failure. On average women were 5 years older than men (p<0.001), were less likely to have had echocardiography (p<0.001), and if previously diagnosed with heart failure less likely to be treated with ACE-inhibitors (p<0.001), â-blockers (p=0.033) or aldosterone antagonists (p<0.001) at admission. In-hospital mortality was 15%. Age-adjusted mortality was higher in men (16% vs. 14%) (p=0.042). 75% of patients were admitted with moderate to severe symptoms (NYHA class III or IV). Women were less likely to be prescribed anti-failure medication, except diuretics, on discharge (p<0.001). Only 20% of patients had planned specialist heart failure follow up, with <1% referred for rehabilitation or specialist palliative care.

Conclusion Many patients admitted to acute hospitals in England, Wales and Northern Ireland are not being managed fully in accordance with international evidence-based guidelines. In comparison with earlier studies from the UK, the use of echocardiography and ACE-I and &â-blockers has increased, and the length of stay reduced. Only a minority of patients are seen, or followed up, by a specialist service. Women appear to be less well managed against recommended guidelines. Significant and sustained effort is required to address gender inequalities in the provision of heart failure care.

Keywords: Evidence Based Medicine, Heart Failure, International Guidelines

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