{
  "abstract": "Introduction The National Heart Failure Audit (NHFA) produces a yearly analysis of hospital admissions for heart failure (HF) in England and Wales and uses these data to define expected standards of care. In contrast, Northern Ireland (NI) does not currently have a unified assessment of HF admissions, which restricts meaningful comparison with NHFA outcomes and limits the establishment of a reference point for evaluating service provision. For the period examined, NHFA benchmarks specified that echocardiography should be performed during admission in 90% of cases, 60% of patients should receive care on a cardiology ward, 80% should undergo inpatient assessment by a heart failure specialist nurse (HFSN) with universal follow-up within fourteen days post-discharge, and 90% of individuals with heart failure and reduced ejection fraction (EF ≤40%) should be commenced on all four guideline-recommended medical therapies.Aim To establish a baseline of NI acute HF admissions, drawing comparisons to the 2022-23 NHFA targets.Methods This multicentre retrospective observational study was conducted using data from all five trusts in Northern Ireland. 1984 patients with left-sided HF (reduced, mildly reduced and preserved EF respectively) were included. Patients with right-sided heart failure or multi-organ failure were excluded. Electronic health records and discharge letters were used to obtain the relevant information.Results Data from five trusts captured 1984 admissions for heart failure, encompassing both newly diagnosed cases and decompensation of known disease.Of the total population, 1200 patients (61.2%) had an IP echocardiogram compared to the NHFA-recommended 90%. 723 (37.6%) patients had a diagnosis of HFrEF, 162 (19.4%) HFmrEF, and 348 (41.7%) HFpEF respectively.Within the NI cohort, 920 (46.6%) of patients were under the care of the cardiology team compared to the 60% as recommended by the NHFA.Only 58 (6.2%) patients were documented to have had inpatient HFSN review, far lower than the recommended 80%, however this may be underestimated due to incomplete documentation in discharge letters. 780 (44.8%) of discharged patients were reviewed by HFSN, with only 200 (11.8%) seen within the recommended fourteen days.In terms of GRMT, 558 (87.2%) patients with HFrEF were discharged on a beta-blocker, 341 (53.3%) on a mineralocorticoid receptor antagonist (MRA), 445 (69.5%) on a RAAS-inhibitor, and 414 (64.7%) on a SGLT2-inhibitor respectively. Overall, 214 (33.4%) patients were discharged on four pillar therapy. Despite notable variation among drug classes, none meet the recommended NHFA standardConclusion This audit highlights unwarranted variation in inpatient heart failure care and supports the need for standardised benchmarking in Northern Ireland. This audit highlights unwarranted variation in inpatient heart failure care and supports the need for standardised bench marking in Northern Ireland. The findings demonstrate deficiencies in inpatient heart failure, including limited provision of inpatient heart failure nurse specialist support and suboptimal use of the four pillar guided recommended medical therapy, which may contribute to poorer outcomes for patients with heart failure in Northern Ireland.",
  "authors": [
    {
      "affiliations": [
        "NIMDTA, Belfast, United Kingdom"
      ],
      "name": "Ciara O’Hare"
    },
    {
      "affiliations": [
        "NIMDTA, Belfast, United Kingdom"
      ],
      "name": "Nicola Melarkey"
    },
    {
      "affiliations": [
        "SHSCT, Belfast, United Kingdom"
      ],
      "name": "Orla Graham"
    },
    {
      "affiliations": [
        "NIMDTA, Belfast, United Kingdom"
      ],
      "name": "Aine Mulholland"
    },
    {
      "affiliations": [
        "NIMDTA, Belfast, United Kingdom"
      ],
      "name": "Ryan Carroll"
    },
    {
      "affiliations": [
        "SHSCT, Belfast, United Kingdom"
      ],
      "name": "Patricia Campbell"
    },
    {
      "affiliations": [
        "BHSCT, Belfast, United Kingdom"
      ],
      "name": "Lana Dixon"
    },
    {
      "affiliations": [
        "WHSCT, Derry, United Kingdom"
      ],
      "name": "Sinead Hughes"
    },
    {
      "affiliations": [
        "SEHSCT, Belfast, United Kingdom"
      ],
      "name": "Mark McGowan"
    },
    {
      "affiliations": [
        "NHSCT, Antrim, United Kingdom"
      ],
      "name": "Karen Darragh"
    },
    {
      "affiliations": [
        "NHSCT, Antrim, United Kingdom"
      ],
      "name": "Aileen Kearney"
    }
  ],
  "title": "110 NI heart failure: benchmarking against NHFA",
  "uid": "f4d0f34e-ba08-55f7-8be5-d08845cc0d23"
}