Heart Failure Discharge Checklist for Improving Quality of Care

Abstract

Does evaluating the quality of heart failure (HF) care prior to discharge improve adherence to guideline-recommended care and equitable patient outcomes? A checklist tool was developed and implemented to measure and improve adherence against the 2022 European Society of Cardiology (ESC) Quality Indicators (QIs) for the care and outcomes of adults with heart failure. A retrospective audit was undertaken to evaluate performance against a checklist tool for 50 outpatients at discharge from a single-centre tertiary New Zealand hospital with a nurse practitioner/nurse specialist-led adult heart failure service. Performance measures were achieved for diagnosis of HF type by echocardiogram (ECHO), health practitioner review, and prescription of beta blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors. Rate of mineralocorticoid receptor antagonist prescriptions, screening for iron deficiency, cardiovascular risk assessment, documentation of QRS duration, and consideration of device therapy improved. Adoption of sodium/glucose cotransporter-2 inhibitors was limited by funding in the New Zealand context. Service constraints for repeat ECHO, HF rehabilitation programs, and use of a validated assessment tool to measure quality of life are targets for improvement. Adopting a discharge checklist improved interprofessional consistency in achieving optimal and individualised guideline-recommended care for patients, whilst improving service efficiency.