NCEPOD Heart Failure report recommendations (2018)
The NCEPOD report sets out some key recommendations for heart failure management in the acute setting. Please refer to the full report for more detail.
Below is a list of some of the recommendations which are particularly relevant to healthcare professionals who may be looking after a heart failure patient but are not heart failure specialists.
Selected list of NCEPOD recommendations4
- A guideline for the clinical management of acute heart failure should be available in all hospitals.
- All patients admitted with acute heart failure should be reviewed by a consultant within 14 hours of admission, or sooner as the clinical need dictates (e.g. cardiogenic shock or respiratory failure) and discussed with a member of the heart failure multidisciplinary team. For patients with worsening symptoms despite optimal specialist treatment, this discussion should include their palliative care needs.
- All heart failure patients should have access to a heart failure multidisciplinary team.
- Medications should be reviewed by a pharmacist with specialist expertise in prescribing for heart failure on admission to and discharge from hospital.
- Serum natriuretic peptide measurement should be included in the first set of blood tests in all patients with acute breathlessness and who may have new acute heart failure.
- An echocardiogram should be performed for all patients with suspected acute heart failure as early as possible after presentation to hospital, and within a maximum of 48 hours as it is the key to diagnosis, risk stratification and specialist management of acute heart failure.
- Due to the poor sensitivity of individual physiological parameters (in particular heart rate) in identifying severity of illness in acute heart failure, use of a composite physiology score such as the National Early Warning Score is recommended.
- All treatment escalation decisions that are not initially made by a consultant should be confirmed by a consultant at the earliest opportunity afterwards. The reasons for treatment escalation decisions should be fully documented in the patient’s records.
- On discharge from hospital, all acute heart failure patients should receive a summary that includes:
- A named healthcare co-ordinator and their contact details
- Their diagnosis and the cause of their heart failure
- Current medications and description of any monitoring required
- Individualised guidance on self-management
- Functional abilities and social care needs
- Follow up plans
- Information on how to access the specialist heart failure team and urgent care