A standardised heart failure pathway that reflects clinical guidelines

We need

  • All patients with heart failure to follow a common heart failure care pathway, which reflects local guidelines and involves all relevant professionals
    (multidisciplinary care) –
    to ensure that patients’ clinical and psychological needs are addressed
  • All patients admitted to hospital with heart failure to receive input from a specialist, regardless of which ward they are admitted to
  • Regular evaluation of the quality of care in hospital and in community settings using the most relevant quality indicators
  • Integration of relevant quality indicators into accreditation programmes for heart failure services1 to encourage consistent adherence to clinical guidelines.

Why

  • Many patients do not receive optimal care as recommended by clinical guidelines.1
  • The quality of heart failure care in hospitals has been proven to improve when led by a specialist. Cardiology wards tend to offer more comprehensive diagnosis2 and greater adherence to clinical guidelines compared to medical wards or primary care. 3
  • Multidisciplinary care programmes are frequently not applied in the mainstream.4 For example in Italy, a study found that only 2 out of the 10 regions analysed had established formalised multidisciplinary care pathways that spanned across hospital and community care settings.5
  • Multidisciplinary working does not just ‘happen’ – and a number of barriers to multidisciplinary working (cultural and system-driven) may need to be overcome, all specific to each healthcare context.6

 

 

 

Prescription of ACE-inhibitors and B-blockers by European specialists

Cardiologists
Netherlands France Spain Italy Romania United Kingdom Sweden Poland Germany ALL
Do you use an ACE inhibitors (%) in:
> 90% of patients 87 85 81 83 68 85 79 78 90 83
Do you use beta blockers (%) in:
> 90% of patients 37 23 21 11 23 26 47 30 56 29
Internists / Geriatricians
Netherlands France Spain Italy Romania United Kingdom Sweden Poland Germany ALL
Do you use an ACE inhibitors (%) in:
90% of patients 71 59 68 68 70 65 44 79 62 64
Do you use beta blockers (%) in:
> 90% of patients 8 8 6 5 16 5 14 21 16 11

Source : Remme at al#

Examples of what has been done:

  • Ponikowski P, Anker S, AlHabib K, et al. Heart failure: preventing disease and death worldwide. : European Society of Cardiology., 2014.

  • González-Juanatey J, Alegría Ezquerra E, Bertoméu Martínez V, et al. Heart Failure in Outpatients: Comorbidities and Management by Different Specialists.The EPISERVE Study. Revista Española de Cardiología 2008;61(6):611-9.

    García Castelo A, Muñiz García J, Sesma Sánchez P, et al. Use of Diagnostic and Therapeutic Resources in Patients Hospitalized to Heart Failure: Influence of Admission Ward Type (INCARGAL Study). Revista Española de Cardiología 2003;56(1):49-56.Comorbidities and Management by Different Specialists.The EPISERVE Study. Revista Española de Cardiología 2008;61(6):611-9.

  • Claes N, Jacobs N, Vijgen J. Impact of heart failure on hospital activity and healthcare costs in Belgium. J Med Econom 2008;11:71-79.

  • Maggioni AS, F. Lo scompenso cardiaco acuto in Italia. G Ital cardiol 2014;15(Suppl 2):3S-4S.

    Consensus conference: il percorso assistenziale del paziente con scompenso cardiaco. G Ital Cardiol 2006;7(6):387.

  • Remme WJ, McMurray JJ, Hobbs FD, et al. Awareness and perception of heart failure among European cardiologists, internists, geriatricians, and primary care physicians. European heart journal 2008;29(14):1739-52.

  • McMurray JJ, Adamopoulos S, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. European journal of heart failure 2012;14(8):803-69.

  • Remme WJ, McMurray JJ, Hobbs FD, et al. Awareness and perception of heart failure among European cardiologists, internists, geriatricians, and primary care physicians. European heart journal 2008;29(14):1739-52.

  • Page K, Marwick T, Lee R, et al. A systematic approach to chronic heart failure care: a consensus statement The Medical Journal of Australia 2014;201(3):146-50.