An overview of the management of Congestive Heart Failure in Malta

Abstract

Background: In July 2003 the National Institute of Clinical Excellence (NICE) issued guidelines on the management of congestive heart failure. We set out to assess the management of congestive heart failure in St. Luke's Hospital (SLH), Malta. Methods: The files of patients admitted to SLH during the month of January 2002 were retrieved. Eligible patients were those with a history of congestive heart failure. Patients who had passed away by the time of the audit or whose files were untraceable were excluded from the audit. Data from the file pertaining to that specific admission was entered in a preprepared data sheet. This includes demographic data about the patient, investigations performed to reach diagnosis and assess severity, pharmacological and non-pharmacological management of heart failure, and planned follow-up at time of discharge. Results: The management of 97 patients was assessed. All patients with a clinical diagnosis of congestive heart failure had an electrocardiogram, chest X-ray, urea, electrolytes and creatinine estimation and a full blood count. Regarding the other tests recommended by NICE, echocardiography was performed in 28% of patients, serum glucose was assayed in 87%, liver function tests in 36%, thyroid function tests in 24%, urinalysis in 13%, lipids in 8% and spirometry in none. Two per cent of patients had lifestyle modification advice documented in the file. Pharmacological treatment consisted of diuretics (98%), ACE inhibitors (71%), angiotensin II receptor blockers (4%), ß-blockers (9%), spironolactone (12%) and digoxin (25%). Conclusions: There is still scope for improvement in the management of congestive heart failure locally.