Heart Failure and Annual Influenza Vaccination Across the Watling Street Primary Care Network: a clinical audit

Introduction

Influenza infection poses a significant risk to patients with chronic heart failure (HF), mediating myocardial inflammation, haemodynamic instability, and acute decompensation. NICE guideline NG106 recommends annual influenza vaccination for all adults with HF. Despite this, vaccination uptake in this population remains inconsistently monitored at the primary care network level. This audit assessed compliance with this recommendation across the Watling Street Primary Care Network (PCN) in 2024.

Method

A retrospective audit of all patients with a coded diagnosis of chronic HF across three practices within the Watling Street PCN (Watling Street Practice @ Great Holm, Shenley Church End, and Stony Stratford) was conducted. Records were reviewed on SystmOne for influenza vaccination receipt during the 2023–24 vaccination period (September 2023 – March 2024). The audit standard was set at 100% in line with NICE NG106. A total of 453 patients were included. Demographic data and reasons for non-vaccination were recorded where available.

Results

453 patients with chronic HF were identified across the PCN. The mean age was 87.9 years (range 17–104). Of these, 382 patients (84.3%) received the annual influenza vaccination during the audit period, falling short of the 100% NICE standard. Recorded reasons for non-vaccination included patient refusal (n=26), no reminder sent via SystmOne (n=4), and no response despite multiple reminders (n=41). Contributory factors in the latter group included previous non-compliance, housebound status, possible transportation difficulties, and potential health literacy barriers.

Conclusion

Vaccination compliance of 84.3% demonstrates a meaningful gap against the NICE standard, with 71 patients unvaccinated. Key drivers include patient hesitancy, system failures in reminder delivery, and access barriers, particularly for housebound individuals. We recommend strengthening automated recall systems, implementing targeted patient education using a Making Every Contact Count (MECC) approach, and exploring home-based vaccination services for patients with mobility limitations. Annual re-audit cycles are proposed to monitor improvement.