Improving inpatient management of acute decompensated heart failure: Re-audit of compliance with 2023 ESC guideline

Acute decompensated heart failure (ADHF) is a common cause of hospital admission, particularly among older adults. The 2023 ESC guideline recommends that patients with known heart failure receiving outpatient diuretics are prescribed 1–2 times their usual oral diuretic dose intravenously on admission. Patients receiving intravenous diuretics should undergo daily monitoring including weight, renal function/electrolytes and fluid balance. This re-audit aimed to assess compliance with these guidelines and improve management of acute DHF in Sunderland Royal Hospital. Clinical records of 25 patients admitted with heart failure in July 2025 were retrospectively reviewed. 11 of these patients were admitted to COTE wards. Patients were categorised according to whether or not they were diuretic naive. For patients with known heart failure, the initial IV diuretic dose was assessed against ESC recommendations. Compliance with daily fasting weights, U&Es and fluid balance documentation was also assessed and compared with the initial audit. Of 25 patients, 17 had known heart failure. An appropriate initial IV diuretic dose was prescribed in 87% of patients with known heart failure, compared with 47% in the initial audit. Among patients receiving IV diuretics, daily fasting weights were documented in 92%, daily U&Es in 84% and fluid balance in 44%. Compliance therefore improved across all audited measures, although fluid balance documentation remained suboptimal. Compliance with ESC recommendations for inpatient management of ADHF improved following the first audit cycle. Areas identified as contributing to ongoing non-compliance included limited awareness of monitoring requirements among ward staff and difficulties accessing appropriate weighing equipment. Interventions included education through the acute medicine bulletin, presentation at a clinical governance meeting and ward-based posters highlighting monitoring requirements. A further re-audit is planned within six months to assess the sustainability of these improvements.