07 October 2014

Specialist treatment necessary for patients with acute heart failure

All people admitted to hospital with suspected acute heart failure should receive treatment from a dedicated specialist heart failure team, according to NICE.

In latest guidance for acute heart failure, NICE has underlined the importance and benefits of specialist treatment for patients with the condition.

Acute heart failure is the leading cause of hospital admission in people over 65, and accounts for more than 67,000 people being admitted to hospital in England each year.

The condition is characterised by the heart failing to pump blood around the body at the right pressure, often as a result of damage to the heart muscle or heart valves but it can sometimes occur in people with no known previous heart dysfunction.

When a person has acute heart failure, they are usually admitted to an accident and emergency department, and those who are not very sick are then admitted to general medical wards or cardiology wards.

However, recent research has shown that while mortality rates for acute heart failure are improving, management and care of the condition still varies widely

An audit from the National Institute for Cardiovascular Outcomes Research found that half of patients admitted with heart failure in England and Wales ended up in non-specialist wards, and had a 54 per cent greater chance of dying as a result.

The audit also found that good clinical management by heart failure and cardiology specialists results in significantly better outcomes for patients.

To improve care and reduce variation in treatment, NICE has produced new guidance on the diagnosis and management of acute heart failure.

The guidance recommends that all hospitals admitting people with suspected heart failure should provide a specialist heart failure team that is based on a cardiology ward and provides outreach services.

In addition, they should ensure that all people being admitted to hospital with suspected heart failure have early and continuing input from a dedicated specialist heart failure team.

Elsewhere, the guidance provides recommendations on the use of early blood tests and echocardiography to diagnose acute heart failure.

The guidance also covers the continuation of treatment with beta blockers after a person has had an episode of acute heart failure.

Dr Suzanna Hardman, Consultant Cardiologist and member of the guideline development group, said: “Untreated acute heart failure kills and can have a serious long-term impact on quality of life, but this can be transformed with specialist care.

“This guideline should ensure all patients admitted to hospital with acute heart failure are cared for by a specialist consultant-led multidisciplinary heart failure team.

“For most, this care will be delivered by a heart failure unit within a cardiology ward but for the few whose needs prioritise care elsewhere, the specialist team will be involved on an outreach basis.”

She added: “The use of tests (natriuretic peptides and early echocardiography) for possible new heart failure will prevent delayed diagnoses.

“The requirement for specialist team review within two weeks of going home will minimise readmissions and integrate acute and community care as outlined in NICE’s chronic heart failure guideline.

“This should result in a reduction in the number of people who die as a result of acute heart failure, improved well-being and less pressure on hospital beds."

Professor Jonathan Mant, Chair of the Guideline Development Group, commented: “The treatment patients with acute heart failure receive, and how successful that treatment is, varies depending on the unit they are admitted to.

“Patients admitted to hospital with heart failure should have early and continued input from a specialist heart failure team.”

“This guideline should ensure all patients admitted to hospital with acute heart failure are cared for by a specialist consultant-led multidisciplinary heart failure team.

Dr Suzanna Hardman, Consultant Cardiologist and member of the guideline development group