Timeliness of echocardiography in patients with acute heart failure: A 2-cycle audit
Abstract
Introduction:
In an acute setting, timely echocardiograms are essential to guide early specialist management of heart failure. National Institute for Health and Care Excellence (NICE) guidelines stipulate a prompt single NT-proBNP measurement and recommend performing transthoracic echocardiography (TTE) within 48 hours of admission in patients with new heart failure with raised naturetic peptide levels. This audit aims to evaluate the timeliness of TTE to assess if they are in-line with national guidelines.
Methods:
An initial baseline audit was conducted to assess current adherence to national guidelines. Data was collected by identifying patients with acute/suspected heart failure from the acute medical take over one week. Baseline characteristics, NT-proBNP measurements and days taken to perform TTE were measured. Following the first cycle, interventions in the form of teaching sessions and interactive posters to reinforce guidelines were implemented. Similar values were re-recorded in the second cycle following intervention, with a further statistic on when the TTE order was placed collected.
Results:
The incidence of heart failure in the baseline audit was 6.75%, with an average age of 80.2 years. Standards measured revealed poor compliance in the baseline audit with regards to BNP measurements done (87%), repeated NT-proBNP measurements (33%), TTE performed during the admission (47%) and TTE done within 48 hours of admission (7%). Following intervention, the second cycle revealed improvements in NT-proBNP measurements (100%), reduced repeated NT-proBNP measurements (reduced to 21%), TTE performed during admission (64%) and within 48 hours (14%). Ony 57% of patients in the second cycle had a TTE requested within 48 hours.
Conclusions:
The audit demonstrated improved adherence with NICE guidelines for investigations in acute heart failure, highlighting the effectiveness of targeted interventions. NT-proBNP measurements should not be repeated unnecessarily during an admission, and TTEs should be promptly ordered in suspected heart failure with raised NT-proBNP values.