Does rhythm matter in acute heart failure? An insight from the British Society for Heart Failure National Audit

Peer reviewedPublisher PD

Variation in hospital performance for heart failure management in the National Heart Failure Audit for England and Wales

Objective: Investigation of variations in provider performance and its determinants may help inform strategies for improving patient outcomes. Methods: We used the National Heart Failure Audit comprising 68 772 patients with heart failure with reduced left ventricular ejection fraction ( HFREF ), admitted to 185 hospitals in England and Wales ( 2007–2013 ). We investigated hospital adherence to three recommended key performance measures ( KPMs ) for inhospital care ( ACE inhibitors ( ACE-Is ) or angiotensin receptor blockers ( ARBs ) on discharge, β-blockers on discharge and referral to specialist follow-up ) individually and as a composite performance score. Hierarchical regression models were used to investigate hospital-level variation. Results: Hospital-level variation in adherence to composite KPM ranged from 50% to 97% ( median 79% ), but after adjustments for patient characteristics and year of admission, only 8% ( 95% CI 7% to 10% ) of this variation was attributable to variations in hospital features. Similarly, hospital prescription rates for ACE-I/ARB and β-blocker showed low adjusted hospital-attributable variations ( 7% CI 6% to 9% and 6% CI 5% to 8%, for ACE-I/ARB and β-blocker, respectively ). Referral to specialist follow-up, however, showed larger variations ( median 81%; range; 20%, 100% ) with 26% of this being attributable to hospital-level differences ( CI 22% to 31% ). Conclusion: Only a small proportion of hospital variation in medication prescription after discharge was attributable to hospital-level features. This suggests that differences in hospital practices are not a major determinant of observed variations in prescription of investigated medications and outcomes. Future healthcare delivery efforts should consider evaluation and improvement of more ambitious KPMs

The cost effectiveness of REACH-HF and home-based cardiac rehabilitation compared with the usual medical care for heart failure with reduced ejection fraction: A decision model-based analysis

Background: The REACH-HF (Rehabilitation EnAblement in CHronic Heart Failure) trial found that the REACH-HF home-based cardiac rehabilitation intervention resulted in a clinically meaningful improvement in disease-specific health-related quality of life in patients with reduced ejection fraction heart failure (HFrEF). The aims of this study were to assess the long-term cost-effectiveness of the addition of REACH-HF intervention or home-based cardiac rehabilitation to usual care compared with usual care alone in patients with HFrEF. Design and methods: A Markov model was developed using a patient lifetime horizon and integrating evidence from the REACH-HF trial, a systematic review/meta-analysis of randomised trials, estimates of mortality and hospital admission and UK costs at 2015/2016 prices. Taking a UK National Health and Personal Social Services perspective we report the incremental cost per quality-adjusted life-year (QALY) gained, assessing uncertainty using probabilistic and deterministic sensitivity analyses. Results: In base case analysis, the REACH-HF intervention was associated with per patient mean QALY gain of 0.23 and an increased mean cost of £400 compared with usual care, resulting in a cost per QALY gained of £1720. Probabilistic sensitivity analysis indicated a 78% probability that REACH-HF is cost effective versus usual care at a threshold of £20,000 per QALY gained. Results were similar for home-based cardiac rehabilitation versus usual care. Sensitivity analyses indicate the findings to be robust to changes in model assumptions and parameters. Conclusions: Our cost-utility analyses indicate that the addition of the REACH-HF intervention and home-based cardiac rehabilitation programmes are likely to be cost-effective treatment options versus usual care alone in patients with HFrEF

ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC.

No abstract available