Performance and opportunity: retrospective cohort study of general medicine heart failure management

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BACKGROUND: Heart failure (HF) is increasingly prevalent, with growing patient complexity. Understanding the quality of care delivered is key to optimising management. AIMS: To characterise HF care by a general medicine service compared to established quality indicators. METHODS: A retrospective cohort review was conducted over a 7-month period. Consecutive general medicine patients admitted with a primary diagnosis of HF were included. Main outcomes measures were baseline guideline-directed medical therapy (GDMT) and index admission medication modifications, planned medical follow-up and 30- and 180-day readmission rates. Comparison to National Heart Foundation quality indicators was undertaken. RESULTS: Two hundred and thirteen patients who survived the index admission were included (median age 86 years (interquartile range 82-89), 53.1% female). Comorbidities included hypertension (69.0%), atrial fibrillation (58.7%) and chronic kidney disease (28.2%). Echocardiography was available for 153 patients (72%), with 26.6% who had HF with reduced ejection fraction (HFrEF) and 62.2% who had HF with preserved ejection fraction (HFpEF). GDMT for HFrEF was 73.2% for beta-blockers, 41.5% for renin-angiotensin system inhibitors, 22.0% for mineralocorticoid antagonists and 9.8% for sodium glucose co-transporter-2 inhibitors (SGLT2i). SGLT2i was prescribed in 2.1% of HFpEF patients. Index admission medication modifications occurred for 40 patients, with 37 initiation/dose escalations and 13 cessation/dose de-escalations. Follow-up was planned in 69.0% patients across multiple services. All-cause readmission rates at 30 and 180 days were 19.2% and 45.5% respectively. CONCLUSIONS: Our HF cohort is elderly and comorbid with high readmission rates. We found low prescription and modification rates of GDMT and poor continuity of care, highlighting areas to improve care in both inpatient and outpatient settings.

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