The Darlington Retrospective Outpatient Study
The Darlington Retrospective Outpatient Study
Having heart failure means the heart is unable to pump blood around the body effectively.
 This reduces life expectancy and hinders normal daily activities. Heart failure affects about
 one million people in the UK; it is a major cause of death but it is often undetected and
 under-treated. If diagnosed and treated properly, the symptoms of heart failure can be well
 controlled and the length and quality of life can be improved.

 Two drugs (called ACE-inhibitors and beta-blockers) help patients to live longer and suffer
 fewer consequences of heart failure. These drugs should be offered to all patients although
 this does not happen consistently for a variety of reasons. Doctors specialising in heart
 failure may help patients make better informed decisions about treatments and other aspects
 of care.

 The purpose of this research is to explore the diagnosis, management and outcome of patients
 with heart failure who are referred to the one stop diagnostic heart failure clinic between
 Jan 2002 and Dec 2007. This study will provide vital information about diagnosis, initiation
 and titration of evidence based medication in the hospital, their follow in the primary care
 and subsequent patient outcome in terms of mortality.
Case notes of all the patients who were referred to the one stop diagnostic heart failure
 clinic during the period (Jan 2002- Dec 2007) will be reviewed and subjects who were found to
 have signs and symptoms of the Heart failure will be identified.

 This cohort of patients will be further analysed and divided on the basis of Echocardiography
 (special scan of the heart that looks at the contraction, relaxation, and the flow of blood
 in the heart chambers) results into two groups.

 1. Those who have impaired contraction (systolic) function of there Left ventricle (left
 side chamber of the heart)

 2. Those who have normal contraction (systolic) function of the left ventricle.

 Case notes of these patients will then be studied in detail with regards to their initial
 presentation, clinical examination, Electrocardiogram (electrical tracing of the heart) and
 chest X ray (picture of the heart and lungs) report.

 These will be co-related with the findings and report of the Echocardiogram.

 Once the diagnosis is established, uptake of evidence based medications (beta blockers, ACE
 inhibitors, spironolactone) and their titration up to the target dose at subsequent follow up
 visits in the heart failure clinic will be examined.

 B) Phase 2 (General practice/ surgery phase)

 This part of the study will be conducted at the GP surgery of the identified patient. This
 will involve accessing the data held at the GP practice with regards to

 1. Was heart failure treatment continued after discharge from the hospital clinic?

 2. If medications continued then for how long?

 3. If medications discontinued then why and by whom (Hospital/GP)?

 4. Current medications and the doses

 5. Admissions to the hospital if any?

 6. Any other co morbidities developed since discharge for the HF clinic?

 7. Outcome in terms of mortality

 8. The cause of death as specified on the death certificate
Inclusion Criteria:

 -  18 years and over attending heart failure clinic between 01/01/2002- 31/12/07

 Exclusion Criteria:

 -  less than 18 years.

 Pregnant females