The national heart failure audit for England and Wales 2008-2009

Objectives To obtain national data on the clinical characteristics, investigation, management and outcome of patients hospitalised with a diagnosis of heart failure. Method A survey was carried out of the first 10 patients hospitalised with a primary diagnosis of heart failure each month in 86 hospitals providing services for acute medical admissions in England and Wales from April 2008 until March 2009. The main outcome measures were rates of investigations, treatments and specialist management, length of hospital stay and mortality. Results The 86 hospitals enrolled 6170 patients with a median age of 78 years (IQR 70-85 years), including 2639 (43%) women. At admission, only 30% of patients were breathless at rest, while 43% had peripheral oedema. Echocardiograms were recorded in 75% of patients and left ventricular ejection fraction (LVEF) was <= 40% in 78%. Natriuretic peptides were rarely measured. Allowing for missing data, > 90% of patients were treated with loop diuretics at discharge, 80% with ACE inhibitors or angiotensin receptor blockers, 50% with beta-blockers and 30% with aldosterone antagonists. Patients with an LVEF < 40% were more likely to receive these agents. Median hospital stay was 9 days (IQR 5-17) and in-patient mortality was 12%. Patients admitted to general medicine rather than cardiology wards were more likely to die (HR=2.5, 95% CI 2.0 to 3.3, p < 0.001) even after adjusting for differences (HR=1.9, 95% CI 1.5 to 2.5, p < 0.001). Projected 1-year mortality below and above age 75 years was 26% and 56%, with higher rates if managed on general medicine rather than cardiology wards (HR=1.4, 95% CI 1.2 to 1.6, p < 0.001). Conclusion The prognosis of patients hospitalised with heart failure remains poor and investigation and treatment suboptimal. Specialist services are associated with higher rates of investigation and treatment and improved outcome.