An audit of inpatient heart failure management-does cardiology care improve rates of evidence based therapy prescribing?

Abstract

Background: Heart failure is a major cause of morbidity and mortality. Optimal implementation of evidence based therapies (EBT) improves outcomes. This audit aims to assess prescription of EBT to acute heart failure patients when led by cardiology teams versus other medical teams in a regional Queensland hospital. Methods: The medical records of the first twenty patients per month, over a 6 month period in 2014, with a primary discharge diagnosis of congestive cardiac failure were reviewed. 120 patientswere included.We examined patient demographics and prescribing rates of EBT according to treating team, Cardiology or non Cardiology. Results: Cardiology took primary care for 82 (68%) of acute heart failure patients and the remaining 38 patients were under non Cardiology teams. Patients treated by Cardiology were significantly more likely to be prescribed ACE/ARB therapy (80.5% vs 60.5%; p=0.02) despite similar rates of patients with contraindications to therapy. Frequency of betablocker therapy prescription was not significantly different (76.8% vs 76.3%; p=NS). Mineralocorticoid antagonist (MRA) use was low in both groups (18% vs 8%; p=NS) with no significant difference between teams, likely due to low numbers in this group. Conclusion: Cardiology teams were more likely to prescribe ACE/ARB in patients presenting with acute heart failure. Rates of beta-blocker prescription were similarly good in both groups. MRA use was low in both groups. Given the established strong evidence base for ACE/ARB use in heart failure, treatment of acute heart failure patients by Cardiology teams should be considered.<br />