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Chronic heart failure in adults: diagnosis and management [NG106]

Measuring the use of this guidance

Recommendation: 1.1.1

The core specialist heart failure multidisciplinary team (MDT) should work in collaboration with the primary care team, and should include: - a lead physician with subspecialty training in heart failure (usually a consultant cardiologist) who is responsible for making the clinical diagnosis - a specialist heart failure nurse - a healthcare professional with expertise in specialist prescribing for heart failure.

What was measured: Proportion of cases where the hospital clinician responsible for the patient did not answer or did not know whether the patient was under the care of the community heart failure team.
Data collection end: December 2016
33.4%
Number that met the criteria: 151 / 452
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: 1.4.1

Offer an angiotensin-converting enzyme (ACE) inhibitor and a beta‑blocker licensed for heart failure to people who have heart failure with reduced ejection fraction. Use clinical judgement when deciding which drug to start first. [2010]

What was measured: Proportion of people with chronic heart failure who have reduced ejection fraction and are prescribed a ACE inhibitor and a beta-blocker.
Data collection end: March 2018
84%
Area covered: National
Source: National Cardiac Audit Programme. National Heart Failure Audit.


Recommendation: 1.4.15

Offer an MRA, in addition to an ACE inhibitor (or ARB) and beta-blocker, to people who have heart failure with reduced ejection fraction if they continue to have symptoms of heart failure. [2018]

What was measured: Proportion of people with chronic heart failure who have reduced ejection fraction and are prescribed an ACE inhibitor, a beta-blocker and a mineralocorticoid receptor antagonist (MRA).
Data collection end: March 2018
47%
Area covered: National
Source: National Cardiac Audit Programme. National Heart Failure Audit.


Recommendation: 1.6.1

Diuretics should be routinely used for the relief of congestive symptoms and fluid retention in people with heart failure, and titrated (up and down) according to need following the initiation of subsequent heart failure therapies. [2003]

What was measured: Proportion of people with heart failure who were prescribed a loop diuretic on discharge.
Data collection end: March 2018
92%
Area covered: National
Source: National Cardiac Audit Programme. National Heart Failure Audit.

What was measured: Proportion of people with heart failure who were prescribed a thiazide diuretic on discharge.
Data collection end: March 2018
5%
Area covered: National
Source: National Cardiac Audit Programme. National Heart Failure Audit.


Recommendation: 1.9.1

Offer people with heart failure a personalised, exercise-based cardiac rehabilitation programme, unless their condition is unstable. The programme: - should be preceded by an assessment to ensure that it is suitable for the person - should be provided in a format and setting (at home, in the community or in the hospital) that is easily accessible for the person - should include a psychological and educational component - may be incorporated within an existing cardiac rehabilitation programme - should be accompanied by information about support available from healthcare professionals when the person is doing the programme.

What was measured: Proportion of hospitals which offer a cardiac rehabilitation service.
Data collection end: December 2016
83.1%
Number that met the criteria: 148 / 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: 1.10.4

People with heart failure and their families or carers should have access to professionals with palliative care skills within the heart failure team.

What was measured: Proportion of hospitals which provide a palliative care service for heart failure patients.
Data collection end: December 2016
97.7%
Number that met the criteria: 171 / 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.

What was measured: Proportion of hospitals with a palliative care clinician on the heart failure multidisciplinary team.
Data collection end: December 2016
29.4%
Number that met the criteria: 48 / 163
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 hospitals with a dedicated palliative care heart failure multidisciplinary team.
Data collection end: December 2016
10.4%
Number that met the criteria: 17 / 163
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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