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Care improving for heart failure patients

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 (NICE) frequently dependent on the type of ward to which patients are admitted. Overall mortality at one year is still poor at 30%.

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% of NHS trusts were able to meet the criteria for auditing their services. As of March 2009, 113 out of 166 trusts (68%) were registered with the audit, with 71 (43%) submitting data.

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

For the two NICE-recommended key treatments for which comparative data is available, access had improved so that:
80% of patients were given ACE inhibitors in 2008/09, compared to 67% in 2005/06.

However, despite this improvement, the report showed 12% 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).

For end-of-life care, of patients who died only 6% 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.”

NHS Information Centre