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Acute heart failure: diagnosis and management [CG187]

Measuring the use of this guidance

Recommendation: 1.1.1

All hospitals admitting people with suspected acute heart failure should provide a specialist heart failure team that is based on a cardiology ward and provides outreach services.

What was measured: Proportion of hospitals with a specialist heart failure service.
Data collection end: December 2016
88.2%
Number that met the criteria: 157 / 178
Area covered: UK
Source: The National Confidential Enquiry into Patient Outcomes and Death. Failure to Function. A review of the care received by patients who died in hospital following an admission with acute heart failure.


Recommendation: 1.1.2

Ensure that all people being admitted to hospital with suspected acute heart failure have early and continuing input from a dedicated specialist heart failure team.

What was measured: Proportion of people with heart failure, who were reviewed by a specialist heart failure team during the inpatient episode.
Data collection end: December 2016
33%
Number that met the criteria: 199 / 603
Area covered: UK
Source: The National Confidential Enquiry into Patient Outcomes and Death. Failure to Function. A review of the care received by patients who died in hospital following an admission with acute heart failure.

What was measured: Proportion of people with heart failure who were reviewed by a cardiologist or member of the heart failure team within 24 hours.
Data collection end: December 2016
27.2%
Number that met the criteria: 114 / 419
Area covered: UK
Source: The National Confidential Enquiry into Patient Outcomes and Death. Failure to Function. A review of the care received by patients who died in hospital following an admission with acute heart failure.


Recommendation: 1.1.4

A follow‑up clinical assessment should be undertaken by a member of the specialist heart failure team within 2 weeks of the person being discharged from hospital.

What was measured: Proportion of hospitals which provide follow-up by a specialist team in either the hospital or the community.
Data collection end: December 2016
97.1%
Number that met the criteria: 168 / 173
Area covered: UK
Source: The National Confidential Enquiry into Patient Outcomes and Death. Failure to Function. A review of the care received by patients who died in hospital following an admission with acute heart failure.


Recommendation: 1.2.2

In people presenting with new suspected acute heart failure, use a single measurement of serum natriuretic peptides (B‑type natriuretic peptide [BNP] or N‑terminal pro‑B‑type natriuretic peptide [NT‑proBNP]) and the following thresholds to rule out the diagnosis of heart failure: -BNP less than 100 ng/litre -NT‑proBNP less than 300 ng/litre.

What was measured: Proportion of hospitals with BNP/NT‑proBNP available for investigation of heart failure.
Data collection end: December 2016
84.2%
Number that met the criteria: 144 / 171
Area covered: UK
Source: The National Confidential Enquiry into Patient Outcomes and Death. Failure to Function. A review of the care received by patients who died in hospital following an admission with acute heart failure.

What was measured: Proportion of newly diagnosed heart failure, where a measurement of natriuretic peptides was carried out.
Data collection end: December 2016
17.9%
Number that met the criteria: 17 / 95
Area covered: UK
Source: The National Confidential Enquiry into Patient Outcomes and Death. Failure to Function. A review of the care received by patients who died in hospital following an admission with acute heart failure.


Recommendation: 1.2.3

In people presenting with new suspected acute heart failure with raised natriuretic peptide levels (see recommendation 1.2.2), perform transthoracic Doppler 2D echocardiography to establish the presence or absence of cardiac abnormalities.

What was measured: Proportion of hospitals with transthoracic Doppler echocardiography available for investigation of heart failure.
Data collection end: December 2016
88.9%
Number that met the criteria: 152 / 171
Area covered: UK
Source: The National Confidential Enquiry into Patient Outcomes and Death. Failure to Function. A review of the care received by patients who died in hospital following an admission with acute heart failure.


Recommendation: 1.2.4

In people presenting with new suspected acute heart failure, consider performing transthoracic Doppler 2D echocardiography within 48 hours of admission to guide early specialist management.

What was measured: Proportion of hospitals with a service to provide echocardiogram within the first 48 hours of admission.
Data collection end: December 2016
65.7%
Number that met the criteria: 115 / 175
Area covered: UK
Source: The National Confidential Enquiry into Patient Outcomes and Death. Failure to Function. A review of the care received by patients who died in hospital following an admission with acute heart failure.


Recommendation: 1.3.3

Offer intravenous diuretic therapy to people with acute heart failure. Start treatment using either a bolus or infusion strategy.

What was measured: Proportion of people with heart failure who received intravenous diuretics were received.
Data collection end: December 2016
79.8%
Number that met the criteria: 473 / 593
Area covered: UK
Source: The National Confidential Enquiry into Patient Outcomes and Death. Failure to Function. A review of the care received by patients who died in hospital following an admission with acute heart failure.



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