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NHS heart failure survey: a survey of acute heart failure admissions in England, Wales and Northern Ireland

¹ Healthcare Commission, London, UK
² Royal Brompton Hospital, London, UK
³ University of Hull, Kingston-upon-Hull, UK
⁴ Cardiac Department, Western Infirmary, Glasgow, UK
⁵ National Heart and Lung Institute, Imperial College, London, UK
⁶ British Society for Heart Failure, British Cardiovascular Society, London UK

Correspondence to:
Dr E D Nicol, Healthcare Commission, Finsbury Tower, 103–105 Bunhill Row, London EC1Y 8TG, UK; e.nicol{at}rbht.nhs.uk

ABSTRACT
Objectives: To obtain national data on demographics, investigation, treatment and short-term outcome for patients admitted with acute heart failure.

Design: Retrospective survey of emergency admissions with acute heart failure 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 9387 records were surveyed. Patients mean age was 77 (SD 11) years, 50% were women and 56% had prior history of heart failure. On average, women were 5 years older than men (80 vs 75 years, p<0.001), were less likely to have had echocardiography (52% vs 60%, p<0.001), and if previously diagnosed with heart failure less likely to be treated with ACE inhibitors (58.3% vs 66.8%, p<0.001), β-blockers (30.1% vs 35.5%, p = 0.033) or aldosterone antagonists (18.9% vs 22.5%, 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 (ACE-I/AIIRA 66.5% vs 73.4%, β-blocker 31.3% vs 37.5%, aldosterone antagonists 23.4% vs 30.1%, all 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 UK studies, the use of echocardiography and ACE-I and β-blockers has increased, and length of stay reduced. Only a minority of patients are seen, or followed up, by a specialist service. Women seem 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.