174 An audit on the management of de novo diagnosis of hfref in the patients presenting with MI in a tertiary centre coronary care unit in the United Kingdom in accord with the European society of cardiology guidelines

Introduction Heart failure (HF) continues to be a significant cause of in-hospital mortality in the United Kingdom while almost one third of the patients who leave hospital alive dies within one year of the HF-related admission.1 De novo diagnosis of HFrEF at an acute presentation with myocardial infarction (MI) presents unique challenges as HF signs at the ACS presentation is an independent predictor for mid-term mortality.3 The disease-modifying treatment which consists of an ACE-i/ARB, a beta-blocker (BB), and an MRA is shown to reduce mortality, hospitalisation and increase quality of life in heart failure with reduced ejection fraction (HFrEF). Furthermore, dapagliflozin or empagliflozin (SGLT-2i) is recommended as an addition to the triad for the patients with persistence HF symptoms.2 While the National Heart Failure Audit (NHFA) has demonstrated an improvement in the rate of in-hospital initiation of the guideline-directed therapy, the rapid titration with early follow-up in the community is of paramount importance to optimise the therapy.1 This audit investigates if the advice in 7 key areas of heart failure management was extended to the community teams in the discharge summaries of patients who presented with myocardial infarction and received de novo diagnosis of HFrEF as inpatients. Methods 67 patients who were admitted with an MI to a tertiary centre coronary care unit in the UK were screened. 15 patients who were diagnosed with de novo HFrEF were included in this retrospective audit. The discharge summaries were checked for 7 areas of advice in line with the ESC Class I recommendations for HFrEF. The areas were if advice to titrate ACE-I/ ARB (1), BB (2), MRA (3) or to start SGLT-2i (4) in the community was given or not, and whether to repeat U&Es (5) was advised in case of dose change in an ACE-I/ ARB or MRA. In addition, the summaries were reviewed to monitor if a repeat TTE was requested (6) and a follow-up plan (7) was documented. Results 36 out of 67 patients presented with STEMI. All patients underwent an inpatient TTE. 15 patients have been found to have reduced left ventricle ejection fraction in addition to 2 patients with known of HFrEF prior to index admission with MI. 10 out of 17 patients had an ejection fraction of 35% or less. (Graph 1) 12 out of 15 eligible patients were started on BB in index admission in addition to 1 patient whose BB dose was increased. Only 3 out of 15 patients whose general practitioners received advice for titration of BB in the community in their summaries. 1 out of 17 patients were on maximum dose of ACE-i/ARB. 10 out of 16 patients who were eligible for titration of ACEi/ARB did not receive advice in their discharge summaries. 9 out of 15 patients were started on MRA during admission. 2 patients were on MRA pre-admission. None of the discharge summaries included advice to titrate MRA in the community. 7 out of 17 patients were on SGLT-2 on discharge. For 10 patients, SGLT-2 inhibitors were indicated but advice to start SGLT-2 inhibitor in the community was not documented in discharge summaries. The GP surgeries of only 6 patients (35%) were advised to repeat renal function and electrolytes. Only 6 out of 17 patients had a repeat TTE booked. 13 out of 16 patients had a follow-up with ACS nurses. While 1 patient with pre-admission diagnosis of HFrEF was followed up only by HF nurses, 1 patient was followed up by both teams. Only 1 patient did not have any follow-up recorded in the discharge summary. Conclusion The NHFA report has revealed that the in-hospital prescription rate of the disease-modifying HF treatment has improved.1 However, the therapy initiation should be followed up by titration in an early follow-up in the community per ESC.2 This audit demonstrated that discharge summaries could be better utilised to advise patients and healthcare professionals in the community for early and rapid titration of the disease-modifying treatment. Conflict of Interest None