Heart failure (HF) occurs when the heart is unable to pump blood around the body as effectively as it should. The main symptoms of heart failure include breathlessness, fatigue and oedema (swelling). HF can occur at any age but prevalence increases with age and it is much more common in older people. HF is a long-term condition that cannot usually be cured and tends to get worse over time, having a profound impact on a person’s quality of life. However, with appropriate medication, symptoms can often be controlled for many years.
HF affects 332 people per 100,000 population – around 65,000 are newly diagnosed each year. Heart failure accounts for 5% of all unplanned admissions to hospital and is estimated to account for 2% of the total NHS budget, with 70% of these costs relating to hospitalisation. Re-admission is particularly common in HF patients with around a quarter of patients readmitted within 30 days of discharge.
Patients who are on optimal medication are less likely to be at risk of an acute decompensation or unplanned admission. Therefore, medicines optimisation in heart failure is critical in managing symptoms, improving quality of life and reducing the amount the NHS spends on acute admissions.
‘Excellence in Heart Failure’ is a structured methodology for delivering improved care and optimised medication for people living with ‘heart failure with reduced ejection fraction’ (HFrEF). This methodology has been used to deliver significant improvements in heart failure care in several localities across England, including Buckinghamshire, Leeds and South Lincolnshire.
The Excellence in Heart Failure methodology includes:
- A code cleaning exercise to ensure that:
- all patients with heart failure are given a heart failure code
- all patients with HFrEF are given the appropriate code
- Desk-top review of all patients coded as having HFrEF to identify patients who are not on optimal treatment
- Face-to-face (or virtual) review of patients who require optimisation of their medication
- Integration of primary, community and secondary HF services (e.g. via a multidisciplinary team set-up) to ensure that referral routes are in place for patients requiring specialist input
- Encouraging self-care
The Oxford AHSN has developed a heart failure toolkit that sets out in detail the steps required to implement Excellence in HF, including suggested search and review criteria.