O3-4.3 Education is associated with the delayed onset of terminal decline

Abstract

<h3>Introduction and aim</h3> Heart failure (HF) poses a staggering clinical and public health problem associated with significant morbidity and mortality. Over the years, there has been significant improvement in the care of patients with HF. Glenfield Hospital (GH) is one of the UK’s largest tertiary cardiology centres, but also provides secondary cardiorespiratory care for a population of approximately 1 million covering Leicestershire and Rutland. Our initial audit in 2012 highlighted the need to improve our HF service. Over the subsequent 5 years, the service has been transformed. We carried out a detailed audit to assess the impact of the improvements made, and to compare our local data against those reported in the most recent published National Heart Failure Audit. <h3>Method</h3> For our initial audit, electronic discharge letters of all patients admitted to GH between 30th March and 13th April 2012 were retrospectively reviewed. Patients treated for HF were identified, and data was then collected for these patients. This Method was used to ensure comprehensive identification of all HF patients. We re-audited the same period (30th March to 13th April) in 2017. <h3>Results</h3> The second audit does not only show significant improvement in length of stay (11 to 7 days), 30 day re-admission (29% to 17%) and inpatient mortality (14.3% to 5.5%) but also the number of HF admissions as a proportion of all admissions has fallen from 11.4% to 7.8%. The prescription rates of ACEi/ARB, Beta-blocker and MRA increased from 69% to 86%, 65% to 80% and 23% to 63% respectively. Tables 1 and 2 show our results compared to the National Heart Failure Audit. We corroborated our results with locally collected coded data (used for submission to NICOR). <h3>Discussion</h3> Following the initial audit in 2012, several changes have been implemented to improve the inpatient HF service. These include an inpatient HF nurse team, nurse led follow-up clinics with ability to see patients urgently, creation of a dedicated HF unit with beds for direct admission from the community, weekly HF MDT meetings, regular educational sessions for junior doctors and nursing staff, and expansion of consultant cover with rapid access one-stop HF clinics. A dedicated cardiology team to review admissions on the Clinical Decisions Unit has ensured patients with HF receive specialist cardiology care from admission. The HF team have also developed strong links with the palliative care team and the local hospice and now have regular palliative care input for symptom management and end of life care. In the most recent audit period, all five patients who died within 30 days of discharge (<b>*</b>) were discharged on a palliative care pathway. Hence, there were no unexpected deaths in this period. This audit is limited by the relatively small numbers. We wanted to perform a detailed analysis of a snapshot of patients to confirm the findings of our coded audit data.