Pumping Marvellous

These are the key findings from the National Heart Failure Audit 2010-2011. The information below indicates the findings of the Audit and key findings.
Between April 2010 and March 2011, 133 out of 156 (85%) NHS Trusts and Welsh Health Boards participated in the audit and submitted data on 36,504 patient records. This is a 71% increase in the number of records collected from 2009/2010.
• Nationally the audit represents approximately 54% of all patients discharged from hospital with a primary discharge diagnosis of heart failure – this is an improvement in case ascertainment from 42% of all patients represented in the 2009/10 audit. However, case ascertainment differs significantly between England (58%) and Wales (7%) and also between individual Trusts
• Data completeness for core fields achieved similarly high rates as in 2009/10.
• Treatment rates at discharge for contemporary disease modifying therapies are similar to last year.
• 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%). This is still suboptimal.
• Only 36% of patients were prescribed aldosterone receptor antagonists (ARA).
• 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).
• In hospital mortality rates were at 11.6%, higher than in contemporary US and European registries.
• 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.
• In-patient mortality rates are better for those admitted to cardiology wards (8%) compared to those in general medical wards (14%) and other wards (17%), figures which are only partly accounted for by known confounders such as age and co-morbidity.
• 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. Again 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 ward.

You can read the full Audit here – Heart Failure Audit 2010-2011

Amias for Chronic Heart Failure

Good news for Heart Failure patients who can’t tolerate ACE inhibitors.

Takeda has highlighted a new ruling by the National Institute for Health and Clinical Excellence (NICE) which will affect Amias, its candesartan cilexetil-based treatment for chronic heart failure patients.

The healthcare regulator has chosen to recommend angiotensin receptor blockers (ARBs) licensed for heart failure – a class of drugs which includes Amias – as an alternative first-line therapy in patients who are unable to tolerate an ACE inhibitor.

Among the factors behind this new ruling was data from clinical trials of Takeda’s drug, demonstrating its efficacy and safety among heart failure patients when compared to a placebo.

It will help to provide a new treatment option for those who are intolerant to ACE inhibitor-based treatments, which can cause coughing among many patients.

Professor John Cleland, professor of cardiology at Hull York Medical School, University of Hull, said: “Candesartan is one of the best studied ARBs and has been shown to improve symptoms, exercise capacity and morbidity.”