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56 Diabetes mellitus and heart failure: a completed quality improvement audit

Heart (British Cardiac Society), 2021, Vol.107 (Suppl 2), p.A50-A50 [Peer Reviewed Journal]

2021 Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ. ;ISSN: 1355-6037 ;EISSN: 1468-201X ;DOI: 10.1136/heartjnl-2021-ICS.56

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  • Title:
    56 Diabetes mellitus and heart failure: a completed quality improvement audit
  • Author: Creechan, P ; Moore, A ; Brennan, A ; Wong, B ; A O’Brien ; Halley, C ; Barrett, M ; Ledwidge, M ; McDonald, K
  • Subjects: Audits ; Diabetes ; Heart failure ; Patients ; Population ; Quality control ; Quality improvement
  • Is Part Of: Heart (British Cardiac Society), 2021, Vol.107 (Suppl 2), p.A50-A50
  • Description: Introduction Diabetes mellitus (DM) and heart failure (HF) have substantial overlap in their risk factors, pathophysiology, and increasingly in their management. The DAPA-HF trial showed decreasing rates of cardiovascular death and HF hospitalisation with the use of the sodium-glucose co-transporter 2 inhibitors in patients with HF with reduced ejection fraction (HFrEF). This quality-improvement audit had the dual aims of improving the collection and recording of glycaemic control (HbA1c) while also improving the identification and treatment of diabetes in a HF population. Methods In the initial audit, the electronic medical records of 200 consecutive patients of the Heart Failure Unit (HFU) were analysed. Patient demographics and HF classification were recorded alongside the date/result of their most recent HbA1c as logged on the St Michael’s Hospital blood database. The subsequent accuracy and databasing of this data on the bespoke HFU patient system that referred to during every patient interaction was then interrogated with variations in integrity recorded. Our intervention took place at a weekly multidisciplinary meeting where results of the above were presented together with education on the increasing importance of identifying diabetes in HF management. Emphasis was also placed on the need for timely recording of a patient’s recent HbA1c on the HF unit database. One month following the above, the records of a further 200 consecutive patients were collected and analysed using the same methodology as the primary audit. Results A combined total of 400 patients were included in the two audits with an average age of 72. Males accounted for 57% of the cohort. HFrEF accounted for 75% of the population. 51% of the population were non-diabetics, 27% were pre-diabetic, 21% type 2 diabetics and 1% were type 1 diabetics. Our primary audit of 200 consecutive patients revealed 35% (n=70) of patients had a HbA1c result available in the last 3 months. 50% (n=35) of these had a HbA1c ≥48. Only 3% (n=5) had the above HbA1c result recorded on the HFU patient record system. Of the 200 patients in the post-intervention audit, 67% (n=133) had a HbA1c result in the preceding 3 months i.e. representing a 32% absolute increase in HbA1c testing. 37% (n=73) had this result subsequently record on the HFU patient record system i.e. representing a 34% absolute increase in reporting. Importantly, 11 patients identified in the secondary audit were newly diagnosed as diabetics suggesting that these new diagnoses were largely secondary to the increased HbA1c testing that occurred as a result of our intervention. Summary/Conclusions We present a completed quality-improvement audit cycle showing a significant increase in HbA1c testing and recording in a busy HF clinic. The data obtained from accurate and consistent HbA1c recording can be used to identify, treat and accurately monitor diabetic control in the HF population.
  • Publisher: London: BMJ Publishing Group LTD
  • Language: English
  • Identifier: ISSN: 1355-6037
    EISSN: 1468-201X
    DOI: 10.1136/heartjnl-2021-ICS.56
  • Source: ProQuest Central
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