Epidemiology, the national audit and guidelines

The National Heart Failure Audit continues to be an invaluable resource for understanding how acute heart failure is managed in England and Wales. The most recent report1 describes just over 37 000 hospitalisations. As in previous publications, fewer than half the patients were managed in cardiology wards, yet those who were had a better outcome; half were referred at discharge to cardiologists for follow-up and they, too, had a better outcome. An innovation in the audit this time was the publication of hospital level analysis. It would be invidious to pick out names, but it is very striking how variable are the rates of such basic items as the use of echocardiography, availability of a cardiologist to manage the patients and the rate of prescription of different drugs.

Studies show that, during long-term follow-up, patients managed by heart failure specialists including ‘heart failure nurses’ are more likely to be treated with the appropriate medication in the appropriate dose, have lower (re-)admission rates to hospital and a better prognosis.2 There is reasonable evidence that there are better outcomes if part of the multidisciplinary intervention is made in the home.3 There is strong evidence that specialist clinics reduce the risk of readmission with heart failure immediately after an index admission.4

Also available to the clinician are the heart failure guidelines from the National Institute for Health and Care Excellence (NICE)5 ,6 and the associated quality standards.7 The NICE standards make it clear what NHS services across England and Wales should be striving towards. Combined with the hospital level analysis from the audit, the quality standards should give clinical teams the ammunition they need when discussing their heart failure service with management teams in both primary and secondary care.

However, it is becoming ever clearer that the …