Does specialist review for patients with suspected heart failure predict better outcomes? An observational study on the utility of compliance with NICE guidelines
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Geraint Morton1, Legate Philip1, Thomas Gilpin1
1Department of Cardiology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, Wessex, UK.
Insights
Patients with suspected heart failure (HF) and elevated N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels benefit from specialist HF clinic review. Compliance with NICE guidelines significantly reduces hospitalizations, supporting their implementation.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Background:
- Heart failure (HF) is a significant cause of morbidity and mortality.
- Elevated natriuretic peptides, such as N-terminal pro-brain natriuretic peptide (NT-pro-BNP), are key indicators of suspected HF.
- National Institute for Health and Care Excellence (NICE) guidelines recommend specialist review for such patients.
Purpose of the Study:
- To compare clinical outcomes between patients with suspected HF and raised NT-pro-BNP who were reviewed in a specialist HF clinic versus those who were not.
- To assess the impact of adherence to NICE guidelines on patient outcomes.
Main Methods:
- Retrospective observational study involving 567 consecutive primary care patients with NT-pro-BNP levels >400 pg/mL.
- Comparison of outcomes between 161 patients referred to a specialist HF clinic (compliant group) and 406 patients not referred (non-compliant group).
- Outcomes measured included all-cause and cardiovascular (CV) hospitalizations and all-cause mortality over a mean 9-month follow-up.
Main Results:
- The compliant group had significantly higher NT-pro-BNP levels (indicating higher risk) but experienced lower rates of all-cause hospitalization (24% vs 44%) and CV hospitalization (3% vs 15%) compared to the non-compliant group.
- Despite higher baseline risk markers, the specialist HF clinic group demonstrated better outcomes regarding hospital admissions.
- No significant difference in all-cause mortality was observed between the groups (6% vs 8%).
Conclusions:
- Specialist HF clinic review is associated with significantly reduced hospitalization rates in patients with suspected HF and elevated NT-pro-BNP.
- Findings support the implementation of NICE guidelines for managing patients with suspected heart failure.
- Early specialist intervention appears crucial for mitigating adverse cardiovascular events, even in high-risk patient cohorts.
Objectives:
Compare outcomes in patients with suspected heart failure (HF) and raised natriuretic peptides who are reviewed in a specialist HF clinic in line with National Institute for Health and Care Excellence (NICE) guidelines (compliant group) versus patients who are not reviewed in the clinic (non-compliant group).
Design:
Retrospective observational study.
Setting:
Single large UK district general hospital.
Participants:
567 consecutive patients in primary care with raised N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels (>400 pg/mL) from February to September 2014.
Interventions:
161 (28%) patients were referred to the specialist HF clinic and 406 (72%) were not. Outcomes were compared between the two groups.
Outcome Measures:
All-cause and cardiovascular (CV) hospitalisations and all-cause mortality.
Results:
The compliant group were slightly younger than the non-compliant group (78±9 vs 80±9; p=0.019) but had much higher NT-pro-BNP (3108±4526 vs 2271±3637 pg/mL; p<0.0001). Despite this, over a mean follow-up period of 9±2 months, rates of all-cause hospitalisation (24% vs 44%; p<0.0001) and CV hospitalisation (3% vs 15%, p<0.0001) were significantly lower in the compliant group versus the non-compliant group, respectively. There was no significant difference in mortality rates (6% compliant group vs 8% non-compliant group; p=0.487).
Conclusions:
Hospitalisation rates in patients with suspected HF and raised NT-pro-BNP were extremely high over a relatively short follow-up period. Patients reviewed in a specialist HF clinic had much higher NT-pro-BNP levels, suggesting they were at higher risk of adverse outcomes, yet also had significantly lower rates of all-cause and CV hospitalisation. Our findings support implementation of the relevant NICE guidelines for patients with suspected HF.
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