Heart Failure (Heart Failure audit)

An elderly woman with consultant

Whether due to congenital heart muscle abnormalities (‘cardiomyopathies’), inflammation of the heart (‘myocarditis’) or damage associated with problems arising from coronary artery or valve disease, the pumping chambers of the heart may increase in size and their pump power reduce (‘heart failure with reduced ejection fraction’ or HFrEF). This may be associated with fatigue and breathlessness and may be associated with dangerous heart rhythm abnormalities and a reduced survival rate. The ejection fraction is a measure of the pumping capability of the heart. Symptoms might also occur in patients with thickened heart muscle which may become stiff. Although the pump power may be retained, the wall of the pump does not relax well, the cavity of the main heart chamber can reduce in size and this leads to back pressure on the blood vessels in the lungs. The syndrome of heart failure can be exactly the same, but this combination is referred to as ‘heart failure with preserved ejection fraction’ or HFpEF.

In the past, symptoms of heart failure could only be improved by the use of diuretics (‘water tablets’) and in some people by the use of digoxin, but over the last two decades new treatments have had an impact on reducing the rate of deterioration of heart muscle problems, have made the patients less prone to dangerous heart rhythm abnormalities and have helped improve symptoms and quality of life. These ‘disease-modifying treatments’ include beta blockers, ACE-inhibitors (ACE-Is), angiotensin receptor blockers (ARBs) and mineralocorticoid receptor antagonists (MRAs).

In some patients with specific characteristics related to a combination of their symptoms, their pump power and the shapes seen on their electrocardiograms (ECGs), the power of the pump may be improved by special pacemaker devices (cardiac resynchronisation therapy or CRT). These devices may also be able to monitor the patient’s heart rhythm and provide special pacing techniques or shock treatment should any life-threatening rhythms occur. Other devices provide these functions but without the resynchronisation function – so called implantable cardioverter defibrillators (ICDs). Most of the research for improved outcomes has been on patients with HFrEF. Ongoing research is looking to see whether new treatments other than that aimed at the causative mechanism might improve outcomes for patients with HFpEF.

Heart Failure Summary Report

National Heart Failure Audit 2019/20 Summary Report

Key messages document and Line of Sight table

Appendix 1 (Introduction to Heart Failure and its Treatment)

Appendix 2 (Methods)

Appendices 3-5 (Random Effects Cox Proportional Models)

Hospital Level Analysis

Hospital Level Table 2019/20

Contact details:

Sarah Ajayi, National Heart Failure Audit Project Manager

Shenaka Singarayer, National Heart Failure Audit Project Coordinator

nicor.auditenquiries@nhs.net

Older reports

National Heart Failure Audit 2018/19 Summary Report

Key messages document and Line of Sight table

Appendix 1 (Introduction to Heart Failure and its Treatment)

Appendix 2 (Methods)

Appendices 3-5 (Random Effects Cox Proportional Models)

Hospital Level Table 2018/19

National Heart Failure Audit 2017/18 Summary Report

Hospital Level Table 2017/18

Patients discharged on all three disease-modifying drugs (ACEIs/ARBs, Beta blockers and MRAs)

National Heart Failure Audit 2016/17 Summary Report

NHFA 2016- 17 Hospital Level Tables

Reports published before 2017

Online NHFA Troubleshooting Session – 10 June 2021

An online webinar with NHFA Clinical Lead, Professor Theresa McDonagh, and the NICOR team presenting dataset changes and new data tools to centres participating in the National Heart Failure Audit.

Powerpoint presentation from the meeting

Q & A from the session

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