RT Journal Article
SR Electronic
T1 Impact of missed treatment opportunities on outcomes in hospitalised patients with heart failure
JF Open Heart
JO Open Heart
FD British Cardiovascular Society
SP e000726
DO 10.1136/openhrt-2017-000726
VO 4
IS 2
A1 Simon Walker
A1 Eldon Spackman
A1 Nathalie Conrad
A1 Connor A Emdin
A1 Ed Griffin
A1 Kazem Rahimi
A1 Mark Sculpher
YR 2017
UL http://openheart.bmj.com/content/4/2/e000726.abstract
AB Objective Many patients with heart failure (HF) do not receive recommended treatments, resulting in suboptimal outcomes. We aimed to investigate the impact of implementing recommended HF therapies on health outcomes, and the costs and effectiveness of interventions for improving adherence.Methods The health benefits of ACE inhibitor (ACEi), beta blockers and optimal therapy (ACEi and beta blockers if not contraindicated) following hospitalisation for HF were combined with evidence on uptake. The aim was to examine how much health was lost as a result of failure to follow guidelines, and how much could be gained using strategies to promote uptake.The net health benefits of different treatments (measured in quality-adjusted life-years (QALY)) were estimated using a decision-analytic model and treatment effectiveness from the literature. Data on the number of patients who would have benefitted from the additional treatments were estimated from 2010 to 2013 using the National Heart Failure Audit.Results Each recommended treatment was associated with positive net health benefit. In 2010, up to 4019 (38.3%) patients would have benefitted from additional treatments rising to 4886 patients in 2013 (although falling to 25.2% of patients). Failure to follow guidelines resulted in large health losses. In 2010, if all patients had received optimal therapy, 1569 QALYs would have been gained, implying a maximum justifiable investment in interventions to promote uptake of £31.4 million.Conclusion Current gaps in translation of evidence to practise in hospitals are associated with significant health losses. Strategies to encourage uptake of guidelines could be effective and cost-effective.