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Original research article
Impact of missed treatment opportunities on outcomes in hospitalised patients with heart failure
  1. Simon Walker1,
  2. Eldon Spackman2,
  3. Nathalie Conrad3,
  4. Connor A Emdin3,
  5. Ed Griffin4,
  6. Kazem Rahimi3 and
  7. Mark Sculpher1
  1. 1Centre for Health Economics, University of York, York, UK
  2. 2Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
  3. 3Department of Population Health, The George Institute for Global Health, University of Oxford, Oxford, Oxfordshire, UK
  4. 4Medical School, University of Exeter, Exeter, Devon, UK
  1. Correspondence to Mr Simon Walker; simon.walker{at}


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.

  • heart failure
  • heart failure treatment
  • beta blockers
  • angiotensin converting enzyme

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  • Contributors SW, ES and MS conducted the analysis. NC, CAE and KR provided evidence on the uptake of the interventions. EG developed the original cost-effectiveness model of HF treatments. All authors contributed to the design of the study and writing of the paper.

  • Funding UK Department of Health Policy Research Programme.

  • Disclaimer This work was funded under the EconomicEvaluation Policy Research Unit (EEPRU) which receives funding from theDepartment of Health Policy Research Programme. EEPRU is a collaborationbetween researchers from two institutions (Centre for Health Economics,University of York and School of Health and Related Studies, Universityof Sheffield). The views expressed in this article are those of the authorsand not necessarily those of the Department of Health.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Data sharing statement Data used in this article is all published and publicly available.

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