Heart Failure Acute and Chronic

Transcription

1 Heart Failure Acute and Chronic Cardiac Services in Wales Acute Heart Failure standards Chronic Heart Failure standards NWIS admissions/readmission data NHFA data Echo accessibility BNP availability Outoatient waits

2 Acute Heart Failure standards key points HF team in each acute hospital Review HF patients by member of team within 24hrs HF unit/ area for care Echocardiogram <48hrs when indicated Discharge - triple therapy Rehabilitation offered <2 weeks team review

3 Acute Heart Failure Pathway CXR, bloods (+/-BNP), ECG (+/-IV diuretics) Identified for HF review 100% Valvular disease/ischaemia pathway Diagnosis confirmed Mx plan 100% Decision to admit under HF team to HF unit (60/40) Echo <48 hrs (if no recent echo) 90% 90% Requiring tertiary care Transferred <48hrs Discharge LVSD: Triple therapy (80%) BB, (80%) ACEI/ARB, (50%) MRA Discharge plan communicated to primary care (100%) HF rehab offered (100%) Post-discharge <2/52 HF review 80% 6/12 exit consult Guideline-based pharmacology and device prescription Exit plan for future Mx (90%) Discharged from HF review (75%)

4 CHF standards key points B-type NP availability Timeliness of HF clinic (and Echo) Triple therapy SHFN/MDT involvement HF follow up 6 month exit consult

5 Chronic Heart Failure Pathway <6/12 of acute admission Use SHFN contact details Known HF - decompensates Primary care review Consider referral back to HF team New HF diagnosis? CXR, bloods (BNP), ECG Consider diuretic Review response and bloods BNP below NICE threshold consider alternative diagnosis (as per NICE) 100% BNP raised Timely Heart failure team review (as per NICE) and Echo LVSD confirmed 100% Valvular disease/ischaemia pathway Guideline-based pharmacology and device prescription LVSD: Triple therapy (80%) BB, (80%) ACEI/ARB, (50%) MRA MDT review (100%) 6/12 exit consult Exit plan for future Mx (90%) Discharged from HF review (75%)

6 n/pmp Heart Failure Admissions (NWIS) 2015 and Wales ABMUHB ABUHB BCUHB C+VUHB CTUHB HDdaUHB

7 Heart Failure Readmissions (NWIS) 2015 and % Wales ABMUHB ABUHB BCUHB C+VUHB CTUHB HDdaUHB

8 Heart Failure Admissions (NHFA) n ! UHB 1 UHB 2 UHB 3 UHB 4 UHB 5 UHB 6 Hospital 1 Hospital 2 Hospital 3 Hospital 4

9 % Heart Failure Patients Received Echo during Admission or <6/12 (NHFA) % ! UHB 1 UHB 2 UHB 3 UHB 4 UHB 5 UHB 6 Hospital 1 Hospital 2 Hospital 3 Hospital 4

10 % Heart Failure Patients seen by Specialist * (NHFA) % ! UHB 1 UHB 2 UHB 3 UHB 4 UHB 5 UHB 6 Hospital 1 Hospital 2 Hospital 3 Hospital 4 *Specialist = Consultant Cardiologist, Consultant with HF remit, Cardiology SpR or SHFN

11 % Heart Failure Patients (with LVSD) followed up by Specialist Heart Failure Nurse (NHFA) % ! UHB 1 UHB 2 UHB 3 UHB 4 UHB 5 UHB 6 Hospital 1 Hospital 2 Hospital 3 Hospital 4

12 Pharmacological Therapy for Heart Failure Patients (with LVSD) % ACE/ARB BB MRA

13 Informal audit of key HF issues 1.Name of your hospital.. 2.B-type NP available for primary care as rule-out? YES/NO 3.B-type NP available in secondary care? YES/NO 4.B-type NP routinely used in assessment of acute breathless patients presenting to acute medical intake (as per NICE) YES/NO 5.Component waits: a) What is your current routine wait for an outpatient echocardiogram? b) What is your current wait for a new heart failure patient outpatient assessment by member of HF team? c) Do the majority of inpatients with suspected diagnosis of HF have full echo studies at your hospital <24hs, 24-48hrs or >48hrs?

14 B-type Natriuretic Peptide Availability in Wales Primary care - available in all UHB as rule out test Secondary care - not available for routine use but in most hospitals can be requested by Cardiology - two hospitals involved in projects assessing use of BNP in patients with SOB?HF presenting acutely

15 Waiting times new HF patients Some variability in the set up for assessment of patients referred as outpatients with possible heart failure Average wait for assessment (12/16 hospitals) = 4 months (range 2 weeks 32 weeks).

16 Echo accessibility Average outpatient wait for echocardiography (12/16 hospitals) = 9 weeks (range 3-11 weeks) Inpatient echo >48 hours in most hospitals

17 Summary Introduce AHF and CHF standards - current evidence that outpatient waits, Echo timeliness and use of BNP in secondary care setting sub-optimal PEDW/NHFA - variable readmission rates, variable prescription of triple therapy, variable access to SHFN Transparent sharing of component waits

18

19 Country-specific HF guidelines (1/5) European Society of Cardiology (ESC) guidelines 1 Updated May 2016 Address mid-range LV function between HF-PEF and HF-REF Replace ACEi with ARNI for patients who are symptomatic despite optimised ACEi/betablocker/MRA therapy Recommend ivabradine for patients: with symptomatic stable HF-REF (LVEF 35%) receiving optimised therapy (including beta-blocker at maximum tolerated dose) in sinus rhythm (resting HR 70 BPM) 1. Ponikowski P, et al ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J, doi: /eurheartj/ehw128

20 Structures HF team HF area Cardiologists/Trainees/SHFN/ GPwSI/Pharmacist/Palliative care 1.Availability of cardiac monitoring 2.Ethos fror HF 3.Daily HF WR and weekly HF MDT 4.IP HF education 5.SHFN presence 6.ardiologists/Trainees/SHFN/ GPwSI/Pharmacist/Palliative care