Title : From regional audit to primary care action: A quality improvement project to implement NICE guidance for HFpEF patients
Abstract:
This project was initiated to address a critical gap between NICE guidance (TA902) and clinical practice in the management of Heart Failure with preserved Ejection Fraction (HFpEF). A trust-level audit revealed that among patients awaiting a specialist heart failure referral, hospitalisation rates were 11%, with a significant number of these patients not on the recommended SGLT2 inhibitor (SGLT2i) therapy. This highlighted a clear need to improve the timely prescribing of SGLT2i in the primary care setting to enhance patients' quality of life and reduce preventable hospital admissions.
A Quality Improvement Project (QIP) was subsequently undertaken at Firth Park Surgery. The baseline was established by reviewing the practice's heart failure register. An EMIS search identified 104 patients, which was then updated and refined to a cohort of 24 patients with a confirmed diagnosis of HFpEF. After a clinical review to exclude patients based on factors like severe frailty or end-of-life care, 11 patients were identified as suitable candidates for SGLT2i therapy.
The intervention involved a multi-disciplinary approach within the practice. The Practice Nurse, a specialist in diabetes management, was engaged to help manage patient consultations. Patients were proactively contacted, educated on the benefits and potential side effects of SGLT2i, and involved in the decision-making process. As a result of this focused effort, 4 of the 11 eligible patients were started on SGLT2i, representing a significant practice-level improvement in prescribing from a baseline of 0% to 37% for this cohort.
This QIP demonstrates that a targeted, primary care-led initiative can successfully translate regional audit findings into tangible improvements in patient care. The key learning emphasizes the need for accurate patient registers, a collaborative team approach, and proactive patient engagement to overcome delays in treatment.
