CLAHRC for Greater Manchester heart failure project identifies hundreds of patients

Our heart failure project has identified over 600 patients who previously had not featured on GP practices’ heart failure registers across Bury CCG.

28 GP practices from across the CCG took part in the project, which aims to improve the quality of care for patients with heart failure. Over the last 18 months, each of these practices has participated in an audit exercise, led by the CLAHRC Heart Failure Specialist Nurses, to assess the validity of their existing heart failure registers, examine current standards of heart failure care and identify patients with confirmed or suspected heart failure who could warrant addition to the heart failure register. The results of these audits provide a foundation for further work within the CLAHRC project, supporting and driving improvements in the accuracy of heart failure registers and the quality of heart failure diagnosis and management in primary care.

Across all participating practices a total of 10,021 patient records were identified and manually audited to identify patients who had a confirmed diagnosis of heart failure but were not on the register, and patients who had signs and symptoms of heart failure or other indications that they required further investigation. The audits resulted in a total of 632 ‘missing’ patients being identified as requiring addition to the heart failure register.

Appropriate diagnosis, treatment and on-going support for heart failure patients can improve quality of life, help reduce morbidity and mortality and reduce hospital admissions. Statistics available from the British Heart Foundation (BHF) indicate that the presence of ‘missing’ heart failure patients is a nationwide problem. While national prevalence of heart failure is 0.7%, the BHF have calculated this figure to be too low, with expected heart failure prevalence thought to be between 1 and 2%. Through participation in the CLAHRC for Greater Manchester heart failure project, Bury CCG has been proactive in addressing this problem at a local level.

Heart failure affects around 900,000 people in the UK and is particularly common among older people, with prevalence expected to increase over the next 20 years. Heart failure can be extremely debilitating, and there is evidence that people with this condition have a worse quality of life than those suffering from most other chronic conditions. As a result, heart failure impacts significantly on the availability of hospital beds and on the number of emergency admissions and re-admissions to hospital. Heart failure accounts for 2% of NHS inpatient days and 5% of all medical admissions to hospital, and it is the largest single reason for emergency bed days due to a chronic condition. Rates of re-admission are also among the highest for any of the other common conditions in the UK.

Following the completion of the audits, we are now supporting the GP practices involved in continuing to improve the quality of their heart failure registers and the diagnosis and management of their patients. Re-audit work will commence later in the year to evaluate the impact and outcomes achieved by the project.