A Quality Improvement Initiative on the ‘Diagnosis and Management of Acute Heart Failure in Older Adults’

Introduction:

Recommendations from the revised European Society of Cardiology (ESC) guidelines (2023) have changed how we manage decompensated heart failure (HF) in acute hospitals. Adherence to ESC guidelines is associated with reduced mortality, readmissions and improved quality of life (www.escardio.org, 2023). This audit was conducted to compare our practice against the above ESC guidelines.

Method:

Two PDSA cycles were completed between July 2024 and April 2025 in the Acute Frailty Unit and two Elderly Care wards. Patients presenting with decompensated HF above 65 years were included. Data were collected from electronic health records on diagnosis of HF and its phenotype, initiation of appropriate guideline-directed medical therapy, and diagnosis and management of anaemia. Interventions post 1st PDSA cycle include departmental teaching, discussing HF phenotype and the management at the board rounds, teaching during ward rounds, presentation at the governance meeting and displaying posters.

Results

The first PDSA cycle included 28 patients, and the second one included 42 patients. Five out of 28 patients (18%) had their phenotype mentioned in the initial clerking, and 11 (39%) in their discharge notes in the first cycle, compared to 23 out of 42 (54.7%) and 27 out of 42 (64.3%) in the second cycle. The patients investigated for iron deficiency improved from 43% to 69%, post intervention. Out of 12 patients with iron deficiency, only 5 received iron infusion in the 1st cycle, whereas 14 out of 15 received in the 2nd cycle (42% to 93%). 10 out of 22 (45%) eligible patients were started on SGLT2i in 1st cycle as opposed to 22 out of 28 (79%) in 2nd cycle. Out of 9 appropriate patients, only 3 were commenced on ACE/ARB/ARNI in the first cycle, which improved to 17 out of 18 post-intervention (33% to 94%). 3 out of 9 (33%) eligible patients were started on MRAs in the 1st cycle, which improved to 13 out of 13 (100%) in the 2nd cycle.

Conclusion

A significant improvement was demonstrated in the management of acute HF, during the second PDSA cycle. The interventions implemented were effective and transferable to similar settings in the UK.