OBJECTIVES:

Many patients with hospitalised heart failure (HF) do not receive treatments as recommended by clinical guidelines, resulting in suboptimal outcomes. We aimed to investigate the potential impact of implementing recommended HF therapies on health outcomes, and to estimate the costs and effectiveness of methods for improving provider adherence.

METHODS:

The health benefits of ACE inhibitor, beta blockers and optimal therapy (ACE inhibitors and beta-blockers if not contraindicated) following hospitalisation for HF were combined with evidence on uptake. The aim was to examine how much health was lost as a result of failure to follow guidelines, and how much could be gained using different strategies to promote uptake.

The net health benefits of the different treatments (measured in quality-adjusted life-years (QALYs)) were estimated using a previously developed decision analytic model and relative effects of treatment from the literature. Data on the number of patients who would have benefitted from the addition of an ACE inhibitor, beta-blockers or optimal therapy (ACE inhibitors and beta-blockers if not contraindicated) was estimated from 2010 to 2013 using the National Heart Failure Audit (NHFA).

RESULTS:

Each treatment recommended in the guidelines was associated with positive net health benefit. In 2010, 4019 (38.3% of) patients would have benefitted from some additional treatments (optimal therapy) rising to 4,886 patients in 2013 (although falling to only 25.2% of HF patients). Failure to follow guidelines is predicted to result in large losses in health. For example, in 2010, if all patients had received the optimal therapies they were eligible to receive, 1,569 QALYs would have been gained, implying a maximum justifiable investment in interventions to promote uptake of £31.4 million.

CONCLUSIONS:

Current gaps in translation of evidence to practice in hospitals are associated with significant health losses. Strategies to encourage the full uptake of guidelines could be effective and cost effective.