The results of the fourth annual National Heart Failure Audit (April 2010-March 2011) have been published and are available at the link below, showing that there are still wide variations in the quality of care provided to patients.

A total of 85% of NHS Trusts and Welsh Health Boards participated in the audit and submitted data on 36,504 patient records (represents approximately 54% of all patients discharged from hospital with a primary discharge diagnosis of heart failure).  Some of the key findings included the following:

• Treatment rates for diuretics (86%) and angiotensin- converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARB) (81%) remain high

• Beta blocker prescription rates are similar to those of last year (65%) and remain suboptimal (although are higher for patients on cardiology wards (78%)

• Only 36% of patients were prescribed aldosterone receptor antagonists (ARAs)

• Treatment rates for ACE inhibitors/ARBs and beta blockers are significantly better when patients are admitted to cardiology rather than general medical wards

• Mortality rates remain high, with 33% of patients in the audit dead at the end of the follow up period (median follow up of 306 days)

• The overall death and/or readmission rate to hospital with heart failure during the period of the audit was 51%, almost identical to last year’s data.

• Mortality rates after discharge are significantly better for those who receive cardiology follow up (18% vs. 31%) and those referred to heart failure specialist nursing services (22% vs. 27%) compared to those who do not (these differences are not solely due to differences in patient characteristics).

• Mortality rates with key medical treatment (ACE Inhibitors/ ARBs, beta blockers, ARAs) are substantially lower than without such therapy. Access to these drugs is higher for patients admitted to cardiology wards.

Professor Theresa McDonagh, the audit's clinical lead, commented that 'this audit underscores the findings of previous years: that use of appropriate medication and access to specialist cardiology had striking benefits, [and] both in-patient and one-year mortality were significantly lower for those admitted to cardiology wards and those having cardiology follow-up.  The ongoing challenge is to change our current models of care so that all patients admitted to hospital with heart failure have access to specialist cardiology care to improve these poor outcomes in the future.'