The Development and Evaluation of the Greater Manchester Heart Failure Investigation Tool (GM-HFIT): A Catalyst for Service Improvement

Introduction Heart failure (HF) is a complex and highly debilitating clinical syndrome. Clear guidelines identify the optimum management of patients living with HF in primary settings but implementation of these is suboptimal.Aim The aim of this service improvement project was to develop a tool kit, The Greater Manchester Heart Failure Investigation Tool (GM-HFIT), to improve the ongoing management of people diagnosed with HF.Methods The GM-HFIT development was informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework. A prospective, pre-test, post-test design informed an audit conducted between 13th February 2012 and 12th December 2013 with data from two clinical commissioning groups (CCGs) across North West Manchester.Results Data from 1146 matched cases were analysed using McNemar tests (SPSS v20). Preliminary analysis suggests that at baseline, 22% of patients were not eligible to be on the HF register, which decreased to 15% after introduction of the tool (P < 0.001). The recording of blood pressure (BP) was high at both time points (95%), while the recording of pulse and rhythm improved from 58% to 64% and 44% to 49% respectively (P = 0.005). While control of BP remained the same (with 62% of patients with target BP <130/70), the proportion of patients receiving the target dose of ACE Inhibitors and beta blockers improved significantly (70% to 85% and 68% to 85% respectively, P < 0.001). In addition 578 missing patients were added to the heart failure register as a result of the case finding element of the project and a further 6 were recommended for further investigation before adding.Conclusion The GM-HFIT service improvment project led to improvements in identification and management of patients with HF in primary care.