Does specialist review for patients with suspected heart failure predict better outcomes? An observational study on the utility of compliance with NICE guidelines

BMJ Open
Geraint MortonPaul R Kalra

Abstract

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). Retrospective observational study. Single large UK district general hospital. 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. 161 (28%) patients were referred to the specialist HF clinic and 406 (72%) were not. Outcomes were compared between the two groups. All-cause and cardiovascular (CV) hospitalisations and all-cause mortality. 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% complian...Continue Reading

References

Feb 13, 2004·The New England Journal of Medicine·Thomas J WangRamachandran S Vasan
Mar 30, 2013·European Journal of Heart Failure·Aldo P MaggioniUNKNOWN Heart Failure Association of the European Society of Cardiology (HFA)
Nov 25, 2017·Heart·Geraint MortonPeter James Cowburn

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