British study finds optimal heart failure care lacking

Kathleen Blanchard's picture
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Heart failure patients are twice as likely to die on a general hospital ward, compared to a cardiology ward, find researchers.

In an audit that tracked hospital admissions in England, researchers found patients with heart failure are better managed on a cardiology ward where they're more likely to get needed tests and specialty management, yet only half were admitted to a heart ward.

The findings come from The national heart failure audit for England and Wales 2008-2009. The authors say, "Currently, hospital provision of care is suboptimal and the outcome of patents poor."

In the survey, 6000 patients were admitted for heart failure symptoms – 30% for characteristic shortness of breath and 43% with swelling of the feet and ankles. The average age was 78 and almost half were women. Those admitted to general wards were less likely to receive recommended investigations.

In the study, women were found to have fewer appropriate diagnostics, compared to men, but death rates were the same. Most of the patients were placed on a heart monitor (75%).

Those who did echocardiogram to measure the ejection fraction, or pumping capability of the heart muscle, were found to have left ventricular ejection fraction (LVEF) less than 40 percent. In four patients, LVEF was unrecorded. Those with poor heart function were more likely to be women, older, and admitted to a general hospital ward.

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In one percent of patients, BNP, natriuretic peptides were measured, despite National Institute of Health and Clinical Excellence recommendations. The blood test is a more sensitive indicator of heart function that echocardiogram.

Patients admitted to non-cardiology, or general wards, tended to be younger, male and twice as likely to die even when other risk factors were considered.

Patients given beta-blocker treatment mostly included men, also found in the study, but only half of the patients audited were prescribed the class of medication that is also a recommended therapy for keeping heart rate slow, lowering the chances of heart rhythm disturbance and aiding the heart’s pumping action.

The study authors concluded heart failure care is suboptimal, based on the audit of 86 hospitals across England and Wales between April 2008 and March 2009. They cite the need for prompt blood testing for natriuretic peptides, availability of trained staff and prompt referral to a specialist to improve heart failure outcomes.

In the study, patients admitted to a general hospital ward for symptoms of heart failure were twice and likely to die, compared to those admitted to a cardiology ward. Other findings showed inadequate diagnostic investigation and failure to prescribe beta-blockers on discharge.

Heart doi:10.1136/hrt.2010.209171
"The national heart failure audit for England and Wales 2008–2009"

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