Queensland Health Clinical Excellence Queensland Statewide Cardiac Clinical Network Queensland Cardiac Outcomes Registry 2018 Annual Report Heart Failure Support Services Audit Improvement | Transparency | Patient Safety | Clinician Leadership | Innovation Queensland Cardiac Outcomes Registry 2018 Annual Report Published by the State of Queensland (Queensland Health), November 2019 This document is licensed under a Creative Commons Attribution 3.0 Australia licence. To view a copy of this licence, visit creativecommons.org/licenses/by/3.0/au © State of Queensland (Queensland Health) 2019 You are free to copy, communicate and adapt the work, as long as you attribute the State of Queensland (Queensland Health). For more information contact: Statewide Cardiac Clinical Network, Queensland Health, GPO Box 48, Brisbane Qld 4001, email [email protected], 15 Butterfield St, Herston Qld 4006, phone 3328 9771 for Statewide Cardiac Clinical Network. An electronic version of this document is available at: clinicalexcellence.qld.gov.au/priority-areas/ clinician-engagement/statewide-clinical-networks/ cardiac Disclaimer: The content presented in this publication is distrib- uted by the Queensland Government as an informa- tion source only. The State of Queensland makes no statements, representations or warranties about the accuracy, completeness or reliability of any information contained in this publication. The State of Queensland disclaims all responsibility and all liability (including without limitation for liability in negligence) for all expenses, losses, damages and costs you might incur as a result of the information being inaccurate or incomplete in any way, and for any reason reliance was placed on such information. QCOR Annual Report 2018 Contents 1 Foreword 1 Heart Failure Support Services Audit 2 Message from the SCCN Chair 2 1 Message from the Heart Failure Steering Committee Chair HF 3 3 Introduction 3 2 Key findings HF 4 4 Executive summary 6 3 Participating sites HF 6 5 Acknowledgements and authors 7 4 New referrals HF 9 6 Future plans 9 4.1 Location of referrals HF 9 7 Facility profiles 10 4.2 Referral source HF 11 7.1 Cairns Hospital 10 7.2 The Townsville Hospital 10 5 Patient characteristics HF 12 5.1 Age HF 12 7.3 Mackay Base Hospital 11 5.2 Gender HF 13 7.4 Sunshine Coast University Hospital 11 5.3 Aboriginal and Torres Strait Islander 7.5 The Prince Charles Hospital 12 status HF 14 7.6 Royal Brisbane and Women’s Hospital 12 5.4 Classification of heart failure by left 7.7 Princess Alexandra Hospital 13 ventricular ejection fraction HF 16 7.8 Gold Coast University Hospital 13 5.5 Summary of patient characteristics HF 18 6 Clinical indicators HF 19 6.1 First clinical review HF 20 6.2 Left ventricular ejection fraction (LVEF) assessed within 2 years of referral to HFSS HF 22 6.3 Prescription of ACEI or ARB for patients with HFrEF HF 23 6.4 Prescription of guideline recommended beta blockers for HFrEF HF 25 6.5 Beta blocker titration HF 27 6.6 Summary of clinical indicators HF 31 7 Patient outcomes HF 32 7.1 Methods HF 32 7.2 Findings HF 33 8 Conclusions HF 38 9 Recommendations HF 39 References i Glossary ii Ongoing initiatives iii QCOR Annual Report 2018 Figures Figure A: Operational structure 3 Heart Failure Support Services Audit Figure B: QCOR 2018 infographic 4 Figure 1: Heart Failure Support Service locations HF 7 Figure 1: Cairns Hospital 10 Figure 2: Regional distribution of new referrals HF 10 Figure 2: The Townsville Hospital 10 Figure 3: Proportion of referrals to HFSS by gender and age group HF 12 Figure 3: Mackay Base Hospital 11 Figure 4: Proportion of all referrals by age group Figure 4: Sunshine Coast University Hospital 11 and Indigenous status HF 15 Figure 5: The Prince Charles Hospital 12 Figure 5: Proportion of HFrEF referrals by gender Figure 6: Royal Brisbane and Women’s Hospital 12 and age group HF 17 Figure 7: Princess Alexandra Hospital 13 Figure 6: Proportion of HFpEF referrals by gender Figure 8: Gold Coast University Hospital 13 and age group HF 17 Figure 7: Inpatients who received first HFSS clinical review within 2 weeks of hospital discharge HF 20 Figure 8: Proportion of non-acute patients who received first HFSS clinical review within 4 weeks of referral HF 21 Figure 9: Proportion of all patients who had LVEF assessed within two years of referral to HFSS HF 22 Figure 10: Proportion of patients who were on ACEI or ARB therapy at time of hospital discharge HF 23 Figure 11: Proportion of patients on ACEI or ARB therapy at time of first clinical review by site HF 24 Figure 12: Proportion of patients on guideline recommended beta blocker at hospital discharge by site HF 25 Figure 13: Proportion of patients on guideline recommended beta blocker therapy at first clinical review by site HF 26 Figure 14: Proportion of patients who had a beta blocker titration review conducted within six months by site HF 27 Figure 15: Proportion of patients who achieved target beta blocker dose at time of titration review by site HF 29 Figure 16: Proportion of patients who achieved target beta blocker dose or maximum tolerated dose at time of titration review HF 30 Figure 17: Heart failure survival by gender HF 34 Figure 18: Heart failure survival by age group HF 34 Figure 19: Heart failure survival by phenotype HF 34 Figure 20: Cumulative incidence of all-cause rehospitalisation HF 35 Figure 21: Cumulative incidence of heart failure rehospitalisation HF 35 Figure 22: Cumulative incidence of all-cause rehospitalisation or death HF 35 Figure 23: Days alive and out of hospital within one year after hospital discharge HF 36 Figure 24: Days alive and out of hospital within one year of discharge by patient characteristics HF 37 Tables Heart Failure Support Services Audit Table 1: Summary of statewide clinical indicator Table 28: Cumulative all-cause unadjusted performance HF 4 mortality rate from 30 to 365 days Table 2: Summary of outcomes for patients after index discharge date HF 33 referred from a hospital setting HF 5 Table 29: Cumulative all-cause unadjusted Table 3: Queensland Heart Failure Support mortality by patient characteristic HF 34 Services (HFSS) facilities and acronyms HF 6 Table 30: Number of rehospitalisations per Table 4: Components of Queensland Heart patient over one year since discharge HF 35 Failure Support Services HF 8 Table 31: Days alive and out of hospital within Table 5: Distribution of new referrals by HFSS one year of discharge by patient location HF 9 characteristics HF 36 Table 6: Source of HFSS referral HF 11 Table 7: Median age of referrals by gender HF 12 Table 8: Number and proportion of referrals to HFSS by gender HF 13 Table 9: Proportion of site referrals identified Aboriginal and Torres Strait Islander HF 14 Table 10: Median patient age by gender and Indigenous status HF 15 Table 11: Proportion of patients by heart failure type HF 16 Table 12: Summary of patient age, gender and Indigenous status by type of heart failure HF 17 Table 13: Summary of patient characteristics HF 18 Table 14: Clinical indicators HF 19 Table 15: Inpatients receiving first HFSS clinical review within 2 weeks of hospital discharge HF 20 Table 16: Non-acute patients receiving first HFSS clinical review within 4 weeks of referral HF 21 Table 17: Patients who had LVEF assessed within two years of referral HF 22 Table 18: Inpatients on ACEI or ARB at time of hospital discharge HF 23 Table 19: Patients on an ACEI or ARB at first clinical review HF 24 Table 20: Patients on guideline recommended beta blocker at hospital discharge HF 25 Table 21: Patients on guideline recommended beta blocker at first clinical review HF 26 Table 22: Patients who had a beta blocker titration review within six months HF 28 Table 23: Patients who achieved target beta blocker dose at time of titration review HF 29 Table 24: Patients who achieved target or maximum tolerated beta blocker dose at time of titration review HF 30 Table 25: Summary of clinical process indicator performance by site HF 31 Table 26: Patient outcome indicators HF 32 Table 27: Eligibility criteria for patient outcome indicators HF 33 1 Foreword As Director General of Queensland Health, I am pleased to present the Queensland Cardiac Outcomes Registry (QCOR) 2018 Annual Report. The Annual Report provides detailed information on the performance of our clinical care for, and outcomes of, people with cardiac disorders. The Annual Report examines a range of clinical areas including cardiac and thoracic surgery, cardiac rehabilitation, cardiac catheter interventions, electrophysiology and pacing, and heart failure support services. This year’s Annual Report includes additional analysis of specific areas of interest to enable examination of clinical issues faced by practitioners at the face of patient care. The Annual Report exemplifies how Queensland Health is Dr John Wakefield PSM meeting its objective to enable safe, high quality services. The Director-General results show that Queenslanders are receiving some of the best Queensland Health cardiac care in the country, and often the world. Queensland Health is committed to empowering our people to provide the best possible healthcare, to be transparent in our work and importantly use information to inform and improve the health outcomes of our patients. The high level of clinical engagement extends beyond clinical practice to working collaboratively with Queensland Health administrators to improve the efficiency of our organisation. Recently, cardiac clinicians and administrators collaborated and used QCOR data to improve the purchasing process of clinical products resulting in savings of $5 million. These funds will now be available in the relevant Hospital and Health Services to reinvest into patient care.