A service improvement ‘tool kit’ for effective heart failure management in primary care

Background:
Heart failure (HF) is a complex and highly debilitating clinical syndrome. International guidelines identify the optimum clinical management of patients living with HF in primary care but translation of these into practice remains inadequate. The aim of this service evaluation is to measure standards of HF diagnosis and management, before and after the implementation of The Greater Manchester Heart Failure Investigation Tool (GM-HFIT), a facilitated ‘tool kit’ designed to optimise HF care.

Methods:
The GM-HFIT was developed as a means of assessing and improving care and was implemented as part of a facilitated service improvement and evaluation in primary care using a prospective, pre-test, post-test design.

Results:
Anonymised pre- and post-audit data were taken from a sample of 1130 cases entered on general practice HF registers. These cases were from two clinical commissioning groups (39 general practices) in the north west of England and were analysed to compare HF management and treatment parameters against clinical guidelines. Implementation of the GM-HFIT tool kit was associated with a reduction in the number of patients inappropriately placed on the HF register (p<0.001), an improvement in the recording and documentation of pulse rate and rhythm (p=0.005) and the proportion of patients receiving the target dose of angiotensin converting enzyme inhibitors and beta-blockers (p<0.001). There was no significant difference in the recording and documentation of blood pressure levels or in documented target blood pressure levels across the time points.

Conclusion:
The introduction of the GM-HFIT kit was associated with statistically significant improvements in the identification and clinical management of patients diagnosed with HF in primary care.