25 A Retrospective Audit of Heart Failure Care in Older Patients at Campbelltown Hospital, NSW, with Reference to the 2017 ACCF/AHA Guideline

Abstract Aim To determine if the management of a cohort of inpatients in our facility is compliant with the best practice guideline for heart failure from the American College of Cardiology 2017 management guideline and whether there were differences between younger and older patients. Method A retrospective ‘snapshot’ audit assessing all patients admitted to Campbelltown Hospital (CTN) with any ICD-10 heart failure code against the ACCF/AHA Guideline. Demographic data was collected; statistical analysis was performed using SPSS®. Results Sixty-three patients met inclusion criteria with a median age of 77 years and 83% from a private residence. A majority were frail (71%) and we found 87% presented with New York Heart Association class II or III heart failure symptoms. No patients received all the therapeutic options recommended by the guideline in our study. The majority if not all patients received basic investigations such as blood pathology and imaging. Compliance was found to be lower for echocardiography, iron replacement where required and use of the angiotensin blocker class of drugs. Comparing older and younger patients, there was a trend for older patients to be less likely to receive more advanced investigations and appropriate medications. Older patients in general have poorer outcomes comparing the younger. Conclusion Our study demonstrates an opportunity to improve compliance with the best practice guidelines for the management of heart failure. A robust coordinated approach, which is institution-centred, is required to improve compliance which has been shown to improve patient and health system outcomes.