title: Audit of a tertiary heart failure outpatient service to assess compliance with NICE guidelines.
abstract: The National Institute for Health and Care Excellence (NICE) updated its guidelines for chronic heart failure (HF) in 2010. This re-audit assessed interim improvement as compared with an audit in 2011. Patients with HF (preserved and reduced ejection fraction) attending a tertiary cardiac centre over a 2-year period (January 2013-December 2014) were audited. The data collected included demographics, HF aetiology, medications, clinical parameters and cardiac rehabilitation. In total, 513 patients were audited. Compared with 2011, male preponderance (71%) and age (68±14 years, (Mean ± SD)) were similar. 73% of patients lived outside of London. HF aetiologies included ischaemic heart disease (37% versus 40% in 2011), dilated cardiomyopathy (26% versus 20%) primary valve disease (13% versus 12%). For patients with left ventricular systolic dysfunction (n=434, 85% of patients audited) 89% were taking beta-blockers (compared with 77% in 2011), 91% an angiotensin converting enzyme inhibitor or angiotensin receptor blocker (86% in 2011) and 56% a mineralocorticoid receptor antagonist (44% in 2011); 6% were prescribed ivabradine. All patients were reviewed at least 6-monthly. Although 100% of patients were educated about exercise, only 21 (4%) enrolled in a supervised exercise programme. This audit demonstrated high rates of documentation, follow-up and compliance with guideline-based medical therapies. A consistent finding was poor access to cardiac rehabilitation.
authors.affiliation: Cardiology Department, Royal Brompton Hospital, London, UK and National Heart and Lung Institute, Imperial College, London, UK, *contributed equally k.guha@rbht.nhs.uk.
authors.forename: Kaushik
authors.initials: K
authors.lastname: Guha
authors.affiliation: Cardiology Department, Royal Brompton Hospital, London, UK, *contributed equally.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Allen
authors.affiliation: Cardiology Department, Royal Brompton Hospital, London, UK and University of Southampton, Southampton, UK.
authors.forename: Sumir
authors.initials: S
authors.lastname: Chawla
authors.affiliation: Cardiology Department, Royal Brompton Hospital, London, UK.
authors.forename: Hayley
authors.initials: H
authors.lastname: Pryse-Hawkins
authors.affiliation: Cardiology Department, Royal Brompton Hospital, London, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Fallon
authors.affiliation: Cardiology Department, Royal Brompton Hospital, London, UK.
authors.forename: Vicki
authors.initials: V
authors.lastname: Chambers
authors.affiliation: Cardiology Department, Royal Brompton Hospital, London, UK.
authors.forename: Ali
authors.initials: A
authors.lastname: Vazir
authors.affiliation: Cardiology Department, Royal Brompton Hospital, London, UK.
authors.forename: Alex R
authors.initials: AR
authors.lastname: Lyon
authors.affiliation: Cardiology Department, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College, London, UK.
authors.forename: Martin R
authors.initials: MR
authors.lastname: Cowie
authors.affiliation: Cardiology Department, Royal Brompton Hospital, London, UK.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Sharma
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000534:rehabilitation*; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy*
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists
keywords: Cardiac rehabilitation; heart failure management; left ventricular systolic dysfunction