However, the National Heart Failure Audit annual report shows that sharp differences in the quality of care patients receive continue to exist, with access to the key therapies recommended by the National Institute for Health and Clinical Excellence frequently dependent on the type of ward to which patients are admitted. Overall mortality at one year is still poor at 30 per cent.

The study covers the period between April 2008 and March 2009 and was jointly run by The NHS Information Centre and the British Society for Heart Failure and funded by the Healthcare Quality Improvement Partnership (HQIP).

Its purpose is to support better care by measuring the quality of care and clinical outcomes of all patients who have been discharged with a diagnosis of heart failure. The audit builds on earlier work carried out by the former Healthcare Commission in 2005/06.

There is a significant improvement in the number of Trusts meeting the clinical audit standards set out in the National Service Framework for CHD. In 2005/06, only 20 per cent of NHS Trusts were able to meet the criteria for auditing their services. As of March 2009, 113 out of 166 trusts (68 per cent) were registered with the audit, with 71 (43 per cent) submitting data.

On diagnostics, the report shows 75 per cent of patients had echocardiography – a key investigation for heart failure – in 2008/09, compared with only 32 per cent in 2007/08.

For the two NICE-recommended key treatments for which comparative data is available, access had improved so that:

• 80 per cent of patients were given ACE inhibitors in 2008/09, compared to 67 per cent in 2005/06
• 46 per cent were given beta blockers in 2008/09, compared to 28 per cent in 2005/06

However, despite this improvement, the report showed 12 per cent of patients did not receive any of the five key treatments which also include loop diuretics, aldosterone receptor antagonists (ARA) and angiotensin II receptor antagonists (ARB)

Nevertheless, in-hospital mortality fell to 10.5 per cent in 2008/09 compared to 15 per cent in 2005/06. The audit showed numbers of patients dying within one year of discharge is 30 per cent.

Despite overall improvements in the quality of diagnosis and care, the report highlighted considerable variation in care and outcomes depending on whether the patient was admitted to a cardiac or general medicine ward.

The outcome for patients admitted to a cardiology ward were significantly better than those admitted to general medicine even after correction for differences such as age, sex, symptoms and treatment.

Patients on a cardiology ward were more likely to be on one of the five key treatments than if they were cared for elsewhere in hospital. They were also more likely to survive, with mortality rates in cardiology wards of 22 per cent , compared to 36 per cent on a general medicine or 41 per cent on other wards.

For end of life care, of patients who died only six per cent were referred to palliative care and likely to reflect the national picture of unmet palliative needs for patients with heart failure.

The NHS Information Centre's chief executive Tim Straughan said: “While it is encouraging to see that the NHS is making significant strides in improving quality of care and outcomes, there is still much to be done.

“Trusts should prioritise participating in this annual piece of work which plays an invaluable role in providing comparative data which can help them scrutinise their service and deliver tangible improvements.

“A key issue for all trusts must be the access their patients get to the key treatments recommended by NICE which are proven to make a real difference to outcomes. The fact that access to these treatments is so variable must be a cause of concern and will no doubt be an issue that clinicians and managers will need to focus on in the weeks and months to come.”

Robin Burgess, Chief Executive of the Healthcare Quality Improvement Partnership (HQIP) said: “This audit shows that considerable progress is being made in this vital area of care. It is pleasing to see how clinical audit strongly forms part of quality improvement, whereby local services supply data for analysis and then local improvements are made. Through clinical audit, services are encouraged to improve and they do. There is more to be done, but these results are very encouraging for those with heart problems of this type.”

Notes to editors

1. The NHS Information Centre (The NHS IC) is England's authoritative, independent source of health and social care information. It works with more than 300 health and social care providers nationwide to provide the facts and figures that help the NHS and social services run effectively. Its role is to collect data, analyse it and convert it into useful information which helps providers improve their services and supports academics, researchers, regulators and policymakers in their work. The NHS IC also produces more than 120 statistical publications each year across a number of areas including: primary care, health and lifestyles, screening, hospital care, population and geography, social care and workforce and pay statistics.
2. The NHS IC is the largest single provider of clinical audits to the NHS and carries out a range of audits, mainly funded by the Healthcare Quality Improvement Partnership, into cancer, heart disease and diabetes.
3. The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP hosts the contract to manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP). Their purpose is to engage clinicians across England and Wales in systematic evaluation of their clinical practice against standards and to support and encourage improvement in the quality of treatment and care. The programme comprises more than 25 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions, including heart failure.
4. Heart failure is a clinical syndrome characterised by symptoms such as breathlessness and fatigue, and signs of fluid retention such as swollen ankles. It is caused when the heart is unable to pump enough blood fast enough to meet the needs of the body. It develops over time as the pumping action of the heart grows weaker. Most cases are due to coronary heart disease and damage following a heart attack. Many cases also reflect damage from high blood pressure, which causes the heart's muscular wall to thicken, making it less flexible and unable to pump blood properly.
5. Heart failure affects at least one in 100 people in the UK, increasing steeply with age to about seven per cent in men and women over 75 -84 years. The number of patients with heart failure is set to rise in the next twenty years. This is due to the combined effects of improved survival after a heart attack and an ageing population.
6. The average age of patients admitted with a first or recurrent episode of heart failure is 78 years. Heart failure is one of the commonest reasons for emergency medical admissions (about five per cent), readmission rates and occupied bed days. Survival rates are worse than for breast and prostate cancer, with annual mortality ranging from ten per cent to 50 per cent depending on severity. Death may be due to progressive heart failure, sudden death or other concomitant disease . Patients with heart failure have a poor quality of life, with over a third experiencing severe and prolonged depressive illness.
7. For further information, call 0845 2576990 or 0113 254 7272.