A heart failure care optimisation project in the north of Scotland

Introduction: This project aimed to assess and optimise the treatment of all patients with heart failure with reduced ejection fraction (HFrEF). Methods: Consecutive patients discharged with a heart failure code (ICD-10) between April 2014 and July 2017 were included. The medical records were reviewed to ensure optimal medical therapy and in cases where this was not being received, a process of ‘active optimisation’ was initiated. Results: Out of 656 patients, 139 were identified as eligible for guideline-directed treatment, 129 (93%) of which were receiving optimal medical therapy. Of these, 47 (36%) were deemed to be optimised but were not on full guideline-directed therapy owing to contraindication, intolerance, comorbidities or non-compliance. Conclusion: The project data reflect real-world patients and practice and highlight a tension between guideline-based care and real-life (realistic) medicine.