Background The most recent National Heart Failure Audit (2013–2014) demonstrated that those patients in medical wards had lower levels of evidenced based therapy and higher levels of mortality. The aims of this audit were to assess management of heart failure in medical and cardiology wards against national guidance to determine standards of care in each and learning points for improvement in care.
Methods A random sample of patients admitted to both medicine and cardiology between Jan 2014 and June 2015 was obtained. A retrospective examination of online hospital records was performed and results compared with National Heart Failure Audit 2013–2014.
Results Overall, 100 patients sampled who were admitted medically and 149 patients sampled who were admitted to cardiology with heart failure during the study period.
Medical patients on average 10 years older than cardiology patients (80.7 ± 10.1 years versus 70.3 ± 12.9 years, p < 0.001) and were more likely to be female (57% vs 23%, p < 0.001). Overall 71% of medical and 99% of cardiology patients had had an ECHO in the year before or after admission, compared with 91% for national heart failure audit. There was a significantly higher portion of patients with moderate to severe LV systolic dysfunction admitted to cardiology (72% vs 28%, p < 0.001). Use of evidenced based therapy in this group and comparison with national audit standards is summarised in Table 1. Medical patients had a higher incidence of a subsidiary diagnosis, for example, sepsis, on discharge (76% vs 16%, p < 0.001), although length of stay was longer for cardiology patients (17.7 ± 14.7 days vs 7.5 ± 7.6 days, p < 0.001). Mortality is summarised in Table 2, and was significantly increased in medical patients, likely due to a combination of increased age and comorbid status, and reduced evidenced based therapy.
Conclusion Comparison of management of heart failure between medical and cardiology wards revealed two different patient groups in terms of; age and comorbid status and ECHO findings. Whilst cardiology patients compared well with national audit standards it appears that medical patients could benefit from greater heart failure team input.
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