Abstract
Purpose: In October 2014 NICE published updated
guidelines on the diagnosis and management of acute heart
failure. The key changes to these guidelines were the use of
serum brain natriuretic peptide (BNP) as a diagnostic tool
for suspected heart failure, transthoracic echocardiography
(TTE) within 48 hours of admission and follow up within
two weeks of discharge. This would potentially require
a significant expansion in service provision in order to
comply with the updated guidance. We audited our current
practice using the NICE guidelines as a benchmark.
Methods: A retrospective analysis of patients coded for
acute heart failure as an admission diagnosis over 24
month period (ICD 10 code 150.) was collected in a large
district general hospital serving a population of 350,000.
Data on basic demographics, how heart failure was
investigated and how we are following up our patients
was collected.
Results: We analysed 294 cases of acute heart failure. The
mean age was 76 years and 57% were male. The median
length of stay was seven days (range 1 to 149 days).
Only four cases (1.4%) had BNP estimations but these
were all after a TTE had been performed due to diagnostic
uncertainty. 159 cases had inpatient TTE (54%) of which
48 were within two days (30%). The median time to TTE
was 4 days.
The number of people seen within two weeks post discharge
was 22 (15%) with a mean time to follow up of 48 days.
The mean was significantly lower in patients followed up
by our specialist nurses compared with our cardiologists
(mean 38 days versus 62 days).
Conclusions: We found that our hospital is a long way
off targets outlined by NICE’s updated acute heart failure
guidelines. Implementing these changes would require
significant service expansion and investment. The use of
BNP is currently unfunded for routine inpatient diagnostic
use with no current funding available to implement.
Expansion in our echocardiography and outpatient
provision would be required to become compliant without
impacting on other services. Our audit would recommend
one additional echocardiographic session and one additional
cardiology clinic per week.
District General Hospitals across the UK are likely to
require similar increases in service to be compliant. This
will incur a significant cost burden to Trusts in times of
decreasing budgets.
guidelines on the diagnosis and management of acute heart
failure. The key changes to these guidelines were the use of
serum brain natriuretic peptide (BNP) as a diagnostic tool
for suspected heart failure, transthoracic echocardiography
(TTE) within 48 hours of admission and follow up within
two weeks of discharge. This would potentially require
a significant expansion in service provision in order to
comply with the updated guidance. We audited our current
practice using the NICE guidelines as a benchmark.
Methods: A retrospective analysis of patients coded for
acute heart failure as an admission diagnosis over 24
month period (ICD 10 code 150.) was collected in a large
district general hospital serving a population of 350,000.
Data on basic demographics, how heart failure was
investigated and how we are following up our patients
was collected.
Results: We analysed 294 cases of acute heart failure. The
mean age was 76 years and 57% were male. The median
length of stay was seven days (range 1 to 149 days).
Only four cases (1.4%) had BNP estimations but these
were all after a TTE had been performed due to diagnostic
uncertainty. 159 cases had inpatient TTE (54%) of which
48 were within two days (30%). The median time to TTE
was 4 days.
The number of people seen within two weeks post discharge
was 22 (15%) with a mean time to follow up of 48 days.
The mean was significantly lower in patients followed up
by our specialist nurses compared with our cardiologists
(mean 38 days versus 62 days).
Conclusions: We found that our hospital is a long way
off targets outlined by NICE’s updated acute heart failure
guidelines. Implementing these changes would require
significant service expansion and investment. The use of
BNP is currently unfunded for routine inpatient diagnostic
use with no current funding available to implement.
Expansion in our echocardiography and outpatient
provision would be required to become compliant without
impacting on other services. Our audit would recommend
one additional echocardiographic session and one additional
cardiology clinic per week.
District General Hospitals across the UK are likely to
require similar increases in service to be compliant. This
will incur a significant cost burden to Trusts in times of
decreasing budgets.
| Original language | English |
|---|---|
| Article number | P415 |
| Pages (from-to) | 155 |
| Number of pages | 1 |
| Journal | European heart journal. Acute cardiovascular care |
| Volume | Vol 4 |
| Issue number | Issue 1, suppl. |
| Publication status | Published - 2015 |