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National reporting and incentive schemes, such as the Quality and Outcomes Framework, introduced in 2004, have not prevented suboptimal management of heart failure in the UK, research published in PLoS Medicine (21 May 2019) has concluded[1]
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The researchers examined the electronic health records of 93,074 people who were newly diagnosed with heart failure between 2002 and 2014, including data from both primary and secondary care.
They found that most people (56%) were diagnosed in hospital rather than in primary care, and only 17% of these people had their diagnosis noted in their GP record in the subsequent 12-month period.
Additionally, prescribed doses of angiotensin-converting-enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists fell below guideline recommendations, at an average of 42%, 29%, and 22% of the target dose, respectively.
The researchers also noted that gaps in care were more common in women and older people.
While early management of heart failure seemed to have improved, with increased rates of diagnostic testing and treatment initiation over time, the researchers suggested that the broader lack of evidence-based care may be a result of inadequate continuity between primary and secondary care.
“Further improvements are likely to require a broader perspective in health services design to support appropriate care at every level of the patient journey,” they concluded.
References
[1] Conrad N, Judge A, Canoy D et al. Diagnostic tests, drug prescriptions, and follow-up patterns after incident heart failure: A cohort study of 93,000 UK patients. PLoS Med 2019;16(5):e1002805. doi: 10.1371/journal.pmed.1002805
