Improving Heart Failure Management in Older People

Improving Heart Failure Management in Older People 

Introduction

Heart failure is a major cause of hospital admission among older people and frequently co-exists with frailty, multimorbidity, cognitive impairment and polypharmacy. These factors increase the complexity of assessment, prescribing and discharge planning. A review of practice on geriatric medicine wards at Royal Preston Hospital identified variation in adherence to guideline-based heart failure management, particularly in documentation of heart failure phenotype, fluid status monitoring and medication optimisation. This project aimed to improve compliance with key heart failure management standards to at least 50%.

Method

A 12-week quality improvement project was undertaken using two Plan–Do–Study–Act (PDSA) cycles. Baseline data were collected retrospectively from 40 older people admitted with heart failure under geriatric medicine. A further 25 patients were reviewed following an educational intervention and 20 patients following implementation of a standardised heart failure checklist. Process measures included documentation of heart failure phenotype and ejection fraction, daily weights, fluid balance monitoring, medication optimisation and discharge planning. The educational intervention focused on heart failure management in the context of frailty and multimorbidity, while the checklist aimed to support consistent daily review and decision-making.

Results

Baseline overall compliance with heart failure management standards was 35%. Following the educational intervention, compliance improved to 40%. After implementation of the checklist, overall compliance increased to 61%, exceeding the predefined target. Documentation of heart failure phenotype improved from 30% to 81%, fluid balance monitoring from 8% to 54%, medication optimisation review from 50% to 72%, and discharge planning from 28% to 45%. The checklist intervention produced the greatest and most sustained improvements across measured standards.

Conclusion

Education improved awareness, but the greatest improvement followed introduction of a simple systems-based checklist. Frailty-aware, standardised approaches can improve the reliability of heart failure management for older people admitted to hospital and may support safer prescribing, monitoring and discharge planning. Further work should evaluate sustainability and patient-centred outcomes, including readmission rates and length of stay.