Clinical Excellence Queensland · 6.3 Prescription of ACEI or ARB for patients with HFrEF HF 23 6.4 Prescription of guideline recommended beta blockers for HFrEF HF 25 6.5 Beta blocker

Clinical Excellence Queensland

Queensland Health

Improvement | Transparency | Patient Safety | Clinician Leadership | Innovation

Statewide Cardiac Clinical NetworkQueensland Cardiac Outcomes Registry

2018 Annual Report Heart Failure Support Services Audit

Queensland Cardiac Outcomes Registry 2018 Annual Report

Published by the State of Queensland (Queensland Health), November 2019

This document is licensed under a Creative Commons Attribution 3.0 Australia licence. To view a copy of this licence, visit creativecommons.org/licenses/by/3.0/au

© State of Queensland (Queensland Health) 2019

You are free to copy, communicate and adapt the work, as long as you attribute the State of Queensland (Queensland Health).

For more information contact:Statewide Cardiac Clinical Network, Queensland Health, GPO Box 48, Brisbane Qld 4001, email [email protected], 15 Butterfield St, Herston Qld 4006, phone 3328 9771 for Statewide Cardiac Clinical Network.

An electronic version of this document is available at: clinicalexcellence.qld.gov.au/priority-areas/ clinician-engagement/statewide-clinical-networks/cardiac

Disclaimer:The content presented in this publication is distrib-uted by the Queensland Government as an informa-tion source only. The State of Queensland makes no statements, representations or warranties about the accuracy, completeness or reliability of any information contained in this publication. The State of Queensland disclaims all responsibility and all liability (including without limitation for liability in negligence) for all expenses, losses, damages and costs you might incur as a result of the information being inaccurate or incomplete in any way, and for any reason reliance was placed on such information.

QCORAnnualReport2018

QCORAnnualReport2018

Contents1 Foreword 1

2 Message from the SCCN Chair 2

3 Introduction 3

4 Executive summary 6

5 Acknowledgements and authors 7

6 Future plans 9

7 Facility profiles 107.1 CairnsHospital 10

7.2 TheTownsvilleHospital 10

7.3 MackayBaseHospital 11

7.4 SunshineCoastUniversityHospital 11

7.5 ThePrinceCharlesHospital 12

7.6 RoyalBrisbaneandWomen’sHospital 12

7.7 PrincessAlexandraHospital 13

7.8 GoldCoastUniversityHospital 13

Heart Failure Support Services Audit

1 Message from the Heart Failure Steering Committee Chair HF 3

2 Key findings HF 4

3 Participating sites HF 6

4 New referrals HF 94.1 Locationofreferrals HF9

4.2 Referralsource HF11

5 Patient characteristics HF 125.1 Age HF12

5.2 Gender HF13

5.3 AboriginalandTorresStraitIslanderstatus HF14

5.4 Classificationofheartfailurebyleftventricularejectionfraction HF16

5.5 Summaryofpatientcharacteristics HF18

6 Clinical indicators HF 196.1 Firstclinicalreview HF20

6.2 Leftventricularejectionfraction(LVEF)assessedwithin2yearsofreferraltoHFSS HF22

6.3 PrescriptionofACEIorARBforpatientswithHFrEF HF23

6.4 PrescriptionofguidelinerecommendedbetablockersforHFrEF HF25

6.5 Betablockertitration HF27

6.6 Summaryofclinicalindicators HF31

7 Patient outcomes HF 327.1 Methods HF32

7.2 Findings HF33

8 Conclusions HF 38

9 Recommendations HF 39

References i

Glossary ii

Ongoing initiatives iii

FiguresHeart Failure Support Services AuditFigure1: HeartFailureSupportServicelocations HF7Figure2: Regionaldistributionofnewreferrals HF10Figure3: ProportionofreferralstoHFSSby

genderandagegroup HF12Figure4: Proportionofallreferralsbyagegroup

andIndigenousstatus HF15Figure5: ProportionofHFrEFreferralsbygender

andagegroup HF17Figure6: ProportionofHFpEFreferralsbygender

andagegroup HF17Figure7: InpatientswhoreceivedfirstHFSS

clinicalreviewwithin2weeksofhospitaldischarge HF20

Figure8: Proportionofnon-acutepatientswhoreceivedfirstHFSSclinicalreviewwithin4weeksofreferral HF21

Figure9: ProportionofallpatientswhohadLVEFassessedwithintwoyearsofreferraltoHFSS HF22

Figure10:ProportionofpatientswhowereonACEIorARBtherapyattimeofhospitaldischarge HF23

Figure11: ProportionofpatientsonACEIorARBtherapyattimeoffirstclinicalreviewbysite HF24

Figure12:Proportionofpatientsonguidelinerecommendedbetablockerathospitaldischargebysite HF25

Figure13:Proportionofpatientsonguidelinerecommendedbetablockertherapyatfirstclinicalreviewbysite HF26

Figure14:Proportionofpatientswhohadabetablockertitrationreviewconductedwithinsixmonthsbysite HF27

Figure15:Proportionofpatientswhoachievedtargetbetablockerdoseattimeoftitrationreviewbysite HF29

Figure16:Proportionofpatientswhoachievedtargetbetablockerdoseormaximumtolerateddoseattimeoftitrationreview HF30

Figure17: Heartfailuresurvivalbygender HF34Figure18: Heartfailuresurvivalbyagegroup HF34Figure19: Heartfailuresurvivalbyphenotype HF34Figure20: Cumulativeincidenceofall-cause

rehospitalisation HF35Figure21: Cumulativeincidenceofheartfailure

rehospitalisation HF35Figure22: Cumulativeincidenceofall-cause

rehospitalisationordeath HF35Figure23: Daysaliveandoutofhospitalwithin

oneyearafterhospitaldischarge HF36Figure24: Daysaliveandoutofhospitalwithin

oneyearofdischargebypatientcharacteristics HF37

FigureA: Operationalstructure 3FigureB: QCOR2018infographic 4Figure1: CairnsHospital 10Figure2: TheTownsvilleHospital 10Figure3: MackayBaseHospital 11Figure4: SunshineCoastUniversityHospital 11Figure5: ThePrinceCharlesHospital 12Figure6: RoyalBrisbaneandWomen’sHospital 12Figure7: PrincessAlexandraHospital 13Figure8: GoldCoastUniversityHospital 13

Heart Failure Support Services AuditTable1: Summaryofstatewideclinicalindicator

performance HF4Table2: Summaryofoutcomesforpatients

referredfromahospitalsetting HF5Table3: QueenslandHeartFailureSupport

Services(HFSS)facilitiesandacronyms HF6Table4: ComponentsofQueenslandHeart

FailureSupportServices HF8Table5: DistributionofnewreferralsbyHFSS

location HF9Table6: SourceofHFSSreferral HF11Table7: Medianageofreferralsbygender HF12Table8: Numberandproportionofreferralsto

HFSSbygender HF13Table9: Proportionofsitereferralsidentified

AboriginalandTorresStraitIslander HF14Table10: Medianpatientagebygenderand

Indigenousstatus HF15Table11: Proportionofpatientsbyheartfailure

type HF16Table12: Summaryofpatientage,genderand

Indigenousstatusbytypeofheartfailure HF17

Table13: Summaryofpatientcharacteristics HF18Table14: Clinicalindicators HF19Table15: InpatientsreceivingfirstHFSS

clinicalreviewwithin2weeksofhospitaldischarge HF20

Table16: Non-acutepatientsreceivingfirstHFSSclinicalreviewwithin4weeksofreferral HF21

Table17: PatientswhohadLVEFassessedwithintwoyearsofreferral HF22

Table18: InpatientsonACEIorARBattimeofhospitaldischarge HF23

Table19: PatientsonanACEIorARBatfirstclinicalreview HF24

Table20: Patientsonguidelinerecommendedbetablockerathospitaldischarge HF25

Table21: Patientsonguidelinerecommendedbetablockeratfirstclinicalreview HF26

Table22: Patientswhohadabetablockertitrationreviewwithinsixmonths HF28

Table23: Patientswhoachievedtargetbetablockerdoseattimeoftitrationreview HF29

Table24: Patientswhoachievedtargetormaximumtoleratedbetablockerdoseattimeoftitrationreview HF30

Table25: Summaryofclinicalprocessindicatorperformancebysite HF31

Table26: Patientoutcomeindicators HF32Table27: Eligibilitycriteriaforpatient

outcomeindicators HF33

Table28: Cumulativeall-causeunadjustedmortalityratefrom30to365daysafterindexdischargedate HF33

Table29: Cumulativeall-causeunadjustedmortalitybypatientcharacteristic HF34

Table30: Numberofrehospitalisationsperpatientoveroneyearsincedischarge HF35

Table31: Daysaliveandoutofhospitalwithinoneyearofdischargebypatientcharacteristics HF36

Tables

QCORAnnualReport2018 Page1

1 ForewordAsDirectorGeneralofQueenslandHealth,Iampleasedto

presenttheQueensland Cardiac Outcomes Registry (QCOR) 2018

Annual Report.TheAnnualReportprovidesdetailedinformation

ontheperformanceofourclinicalcarefor,andoutcomesof,

peoplewithcardiacdisorders.

TheAnnualReportexaminesarangeofclinicalareasincluding

cardiacandthoracicsurgery,cardiacrehabilitation,cardiac

catheterinterventions,electrophysiologyandpacing,andheart

failuresupportservices.Thisyear’sAnnualReportincludes

additionalanalysisofspecificareasofinteresttoenable

examinationofclinicalissuesfacedbypractitionersattheface

ofpatientcare.

TheAnnualReportexemplifieshowQueenslandHealthis

meetingitsobjectivetoenable safe, high quality services.The

resultsshowthatQueenslandersarereceivingsomeofthebest

cardiaccareinthecountry,andoftentheworld.Queensland

Healthiscommittedtoempoweringourpeopletoprovidethe

bestpossiblehealthcare,tobetransparentinourworkand

importantlyuseinformationtoinformandimprovethehealth

outcomesofourpatients.

Thehighlevelofclinicalengagementextendsbeyondclinical

practicetoworkingcollaborativelywithQueenslandHealth

administratorstoimprovetheefficiencyofourorganisation.

Recently,cardiaccliniciansandadministratorscollaboratedand

usedQCORdatatoimprovethepurchasingprocessofclinical

productsresultinginsavingsof$5million.Thesefundswill

nowbeavailableintherelevantHospitalandHealthServicesto

reinvestintopatientcare.

QCORdataallowsustoberesponsivetotheneedsofour

patientsandcommunity.Itisactivelyusedtoinformhowwe

improvetheaccess,equity,safety,efficiencyandeffectiveness

ofourcardiachealthcare.

IwouldliketoacknowledgetheongoingeffortoftheStatewide

CardiacClinicalNetworkanditsmanycliniciansandcolleagues,

whohavecollaboratedtoproducethisAnnualReport.

Dr John Wakefield PSM Director-General Queensland Health

Page2 QCORAnnualReport2018

2 Message from the SCCN Chair Itismypleasuretointroducethe4thQueenslandCardiacOutcomeRegistry(QCOR)AnnualReport.The

activitiesofQCORcontinuetomature,andthisreportgivesusyetanotheropportunitytore-examinethe

reasonsforcontinuingthiswork,aswellasformingastimulustoreinvigorateourefforts.Thechancetoask,

“Whyarewedoingthis?”–alotofeffort,repeatedcommitteemeetings,somelatenights,andoccasional

irritationwithcolleagues,asacounterpoisetotheingrainedcliniciandesiretodotheabsolutebestforevery

patientwecareforandtohavedatatoproveit.Theledgerisstronglytiltedintheaffirmative.

Queenslandisnowacknowledgedashavingsomeofthemostcomprehensivecardiacdatainthecountry,

andthesuccessofthisprogramabsolutelyrestsonthesustainedclinicianparticipationonwhichthe

programmeisbuilt.Everystepfrompatientcare,throughrecordingofdata,tosubmission,reverification

andanalysisisheavilyinvestedbytheclinicians.Thisintensiveparticipationtowardsacommongoalhas

certainlydrawnthecardiaccommunitytogetherandwecanberightlyproudofthecohesivenessofthe

effortstoimprovecareacrossthestate.

Thereportthisyearfurtherextendsimportantelementsofpatientcare–wehaveastrongcollaboration

withQueenslandAmbulanceService(QAS),andnowhaveaccesstoquitecomprehensiveprehospitalcare

includingQASadministeredthrombolysisandoutcomes.InastateaslargeasQueenslanditiscriticalthat

wetracktheseimportantaspectsofcare.Thedocumentationofposthospitalcardiacrehabilitationand

heartfailuremanagementcontinuestoprovideamorecomprehensivepictureextendingthewindowofacute

admissionandwithoutdoubtaddingtothesafetyofouracuteinterventions.

Itisgratifyingtoseethatproceduraloutcomesacrossalloftheparticipatinginstitutionsremainstableand

ofhighquality.

Finally,oneoftheimportantreasonswhichcliniciansoriginallyidentifiedsupportingparticipationinthe

programhascometofruition–thecardiacdataderivedfromQCORhasnowledtospecificinvestmentby

thestategovernmentintheprocessesofcardiaccare.Inthecomingyear,inaninitialinvestmentrollout,

hospitalsinCairnsandTownsvillewillsignificantlyexpandtheiroutreachintoruralandremotecentresin

TorresandCapeandacrosstotheNorthWestHospitalandHealthService.QCORdatahasclearlyprofiled

boththeneedandtheshortfallofcardiacservicesintheseareasandhasledtoarecognitionofour

responsibilitiesfordeliveringsafeandefficacioustreatmentbothforpatientswholiveclosetomajorcentres,

butalsoespeciallyforthosefarremoved.ThisprogrammewillextendtotheremainingHospitalandHealth

Servicesinamulti-yearinvestment.

Again,Igivethankstoalloftheclinicianswhocontinuetoparticipateinthisimportantwork.Inthecoming

year,QCORwillhavethecapacitytoinviteprivatecardiacprovidersinthestatetosubmitdatatoQCOR,so

thatwecanobtainamorecompletepicturebothpublicandprivate,ofcardiacservicesacrossthestate.

AspecialthanksisgiventotheStatewideCardiacClinicalInformaticsUnittechnicalandadministrativestaff

whocontinuetosupplysuperbassistancetotheprogramandwhoaretrulyintegraltothequalityofthe

attachedreport.

Dr Paul Garrahy

Chair

Statewide Cardiac Clinical Network


3 IntroductionTheQueenslandCardiacOutcomesRegistry(QCOR)isanever-evolvingclinicalinformationcollectionwhichenablescliniciansandotherkeystakeholdersaccesstoquality,contextualisedclinicalandproceduraldata.OnthebackgroundofsignificantinvestmentanddirectionfromtheStatewideCardiacClinicalNetwork(SCCN)andundertheauspicesofClinicalExcellenceQueensland,QCORprovidesanalyticsandoverviewforseveralclinicalinformationsystemsanddatabases.Byutilisingextensiveancillarycomplementaryadministrativedatasets,asophisticatedlevelofmulti-purposereportingandinsighthasbeengained.

QCORdatacollectionsaregovernedbybespokeclinicalcommitteeswhichprovideoversightanddirectiontoreportingcontentandanalysisaswellasinformingdecision-makingforfutureendeavours.ThesecommitteesaresupportedbyStatewideCardiacClinicalInformaticsUnit(SCCIU)whoformthebusinessunitofQCOR.AllprocessesandgroupsreporttotheSCCN,whichisfacilitatedbyClinicalExcellenceQueensland.

ThestrengthoftheRegistrywouldnotbepossiblewithoutsignificantclinicianinput.Assistingtomaintainquality,relevanceandcontextthroughQCORcommittees,cliniciansarecontinuallydevelopingandevolvingtheanalysisandfocusofeachspecificgroup.TheSCCIUperformstheroleofcoordinatingtheseindividualQCORcommitteeswhicheachhavetheirindividualdirectionanduniquerequirements.

TheSCCIUprovidethereporting,analysis,anddevelopmentofthemanyclinicalcardiologyandcardiothoracicsurgicalapplicationsandsystemsinuseacrossQueenslandHealth.TheSCCIUalsoprovidesdataqualityandauditfunctionsaswellasexperttechnicalandinformaticsresourcesfordevelopment,maintenanceandcontinualimprovementofspecialisedclinicalapplicationsandrelevantsecondaryuses.

TheSCCIUteamconsistsof:

•MrGrahamBrowne–DatabaseAdministrator • DrIanSmith,PhD–Biostatistician•MrMichaelMallouhi–ClinicalAnalyst • MrWilliamVollbon–Manager

•MrMarcusPrior–InformaticsAnalyst • MrKarlWortmann–ApplicationDeveloper

This2018QCORreportnowincludesatotalof6clinicalaudits.TheadditionofthethoracicsurgeryauditreportcomplementstheexistingcardiacsurgeryreporttoenableaclearerpictureoftheworkundertakenbycardiacandthoracicsurgeonsinQueensland.Thisworkreflectseffortsinthisspaceandthehighlightsthevastpatientcohortthatareencounteredbycliniciansworkinginthisspecialty.ItiswiththiscontinualdevelopmentandevolutionofclinicalreportingmaturitythatQCORhopestofurthersupportcardiothoracicclinicalinformaticsintothefuture.

Tier 4: Steering CommitteeStatewide Cardiac Clinical Network

Tier 3: Executive DirectorHealthcare Improvement Unit

Tier 2: Deputy Director GeneralClinical Excellence Division

Tier 1: Director General

QCOR Business UnitSCCIU

QCORAdvisory Committee

QCORElectrophysiology

and PacingCommittee

QCORInterventional

CardiologyCommittee

QCORCardiac

RehabilitationCommittee

QCORHeart Failure

Committee

QCORCardiac Imaging

Committee

QCORCardiothoracic

SurgeryCommittee

Figure A: Operational structure


11% Hospital spending on cardiovascular disease

1 in 5admitted to hospital†

766,000 aged 65 years or older†

15% of total disease burden

is caused bycardiovascular disease†

16%Coronary heart diseaseis the leading cause of

death

>5 millionpopulation*

2018 Activity at a GlanceQueensland Cardiac Outcomes Registry

Thoracic Surgery Audit Interhospital transfer for coronary intervention review

What’s new?

Continuing our work

Clinical indicator progress

Case and patient volumesThe health of Queenslanders

Electrophysiology and pacing clinical indicators Cardiac rehabilitation patient outcome measures

Thrombolysis for STEMI analysis Body mass index in cardiac surgery investigation

Data linkage opportunities Structural heart disease application

National registry alignment Cardiac outreach application

Clinical indicator review ECG Flash project

Reference 1” please use an asterisk glyph.Reference 2 = dagger glyph,Reference 3 = double dagger

Reference 4 = paragraph symbol

4,867percutaneous coronary

interventions

11,723cardiac rehabilitation

referrals

850adult thoracic surgeries

2,384adult cardiac surgeries

4,878new heart failure support

services referrals

148transcatheter aortic valve replacement procedures

95%of cardiac

rehabilitation referrals within 3 days of

discharge

0.3%procedural tamponade rate for cardiac device and electrophysiology

procedures

85 minsmedian first

diagnostic ECG to reperfusion time for

primary PCI

0.9%mortality rate for

coronary artery bypass surgery at 30 days

92% of patients referred to a heart failure support service on an ACEI or

ARB at discharge

3,136cardiac electronic

implantable device procedures

401structural heart disease

interventions

4,474electrophysiology and

pacing procedures

23% have untreated

high blood pressure

11% smoke daily†

4.6% Aboriginal and Torres Strait

Islander population‡

31% have untreated

high total cholesterol

28%of all deaths due

to cardiovascular disease

4.8% have diabetes§

2 in 3 are overweight

or obese†

63% are sufficiently active†

Figure B: QCOR 2018 infographic


11% Hospital spending on cardiovascular disease

1 in 5admitted to hospital†

766,000 aged 65 years or older†

15% of total disease burden

is caused bycardiovascular disease†

16%Coronary heart diseaseis the leading cause of

death

>5 millionpopulation*

2018 Activity at a GlanceQueensland Cardiac Outcomes Registry

Thoracic Surgery Audit Interhospital transfer for coronary intervention review

What’s new?

Continuing our work

Clinical indicator progress

Case and patient volumesThe health of Queenslanders

Electrophysiology and pacing clinical indicators Cardiac rehabilitation patient outcome measures

Thrombolysis for STEMI analysis Body mass index in cardiac surgery investigation

Data linkage opportunities Structural heart disease application

National registry alignment Cardiac outreach application

Clinical indicator review ECG Flash project

Reference 1” please use an asterisk glyph.Reference 2 = dagger glyph,Reference 3 = double dagger

Reference 4 = paragraph symbol

4,867percutaneous coronary

interventions

11,723cardiac rehabilitation

referrals

850adult thoracic surgeries

2,384adult cardiac surgeries

4,878new heart failure support

services referrals

148transcatheter aortic valve replacement procedures

95%of cardiac

rehabilitation referrals within 3 days of

discharge

0.3%procedural tamponade rate for cardiac device and electrophysiology

procedures

85 minsmedian first

diagnostic ECG to reperfusion time for

primary PCI

0.9%mortality rate for

coronary artery bypass surgery at 30 days

92% of patients referred to a heart failure support service on an ACEI or

ARB at discharge

3,136cardiac electronic

implantable device procedures

401structural heart disease

interventions

4,474electrophysiology and

pacing procedures

23% have untreated

high blood pressure

11% smoke daily†

4.6% Aboriginal and Torres Strait

Islander population‡

31% have untreated

high total cholesterol

28%of all deaths due

to cardiovascular disease

4.8% have diabetes§

2 in 3 are overweight

or obese†

63% are sufficiently active†

* AustralianBureauofStatistics.Regionalpopulationgrowth,Australia,2017-2018.Cat.no.3218.0.ABS:Canberra;2019

† QueenslandHealth(2018).ThehealthofQueenslanders2018.ReportoftheChiefHealthOfficerQueensland.Brisbane.QueenslandGovernment

‡ AustralianBureauofStatistics.EstimatesofAboriginalandTorresStraitIslanderAustralians,June2016.Cat.no3238.055001.ABS:Canberra;2018

§ DiabetesAustralia.Statestatisticalsnapshot:Queensland.Asat30June2018;2018


4 Executive summaryThisreportencompassesproceduresandcasesfor8cardiaccatheterisationlaboratories(CCL)andelectrophysiologyandpacing(EP)facilitiesand5cardiothoracicsurgeryunitsoperatingacrossQueenslandpublichospitals.Italsoincludesreferralstoclinicalsupportandrehabilitationservicesforthemanagementofheartdiseaseincluding22heartfailuresupportservicesand55cardiacrehabilitationoutpatientfacilities.

•15,436diagnosticorinterventionalcaseswereperformedacrossthe8publiccardiaccatheterisationlaboratoryfacilitiesinQueenslandhospitals.Ofthese,4,867involvedpercutaneouscoronaryintervention(PCI).

•PatientoutcomesfollowingPCIremainencouraging.The30daymortalityratefollowingPCIwas1.9%,andofthe94deathsobserved,74%wereclassedaseithersalvageoremergencyPCI.

•InanalysisforpatientswithSTEMI,themediantimefromFdECGtoreperfusionandarrivalatPCIfacilitytoreperfusionwasobservedat85minutesand42minutes.Thiscomparesfavourablytoresultsforpreviousyearsandinternationally.

•Acrossthefoursiteswithacardiacsurgeryunit,atotalof2,384caseswereperformedincluding1,414CABGand1,005valveprocedures.

•Asinpreviousyears,observedratesforcardiacsurgerymortalityandmorbidityareeitherwithintheexpectedrangeorbetterthanexpected,dependingontheriskmodelusedtoevaluatetheseoutcomes.Onceagaintheexceptionwastherateofdeepsternalwoundinfection.

•TheCardiacSurgeryAuditincludesafocusedsupplementonobesityincardiacsurgery.Thisreporthighlightstheincreasedrateofpost-operativemorbidityandmortalityforpatientswithahigherBMI(>30kg/m2).

•Thefivepublichospitalsprovidingthoracicsurgeryservicesin2018performedatotalof850cases.Almostone-third(30%)ofsurgeriesfollowedapreoperativediagnosisofprimarylungcancerorpleuraldisease(33%).ThisisthefirstQCORAnnualReporttoexaminethoracicsurgery,andthiswillbeexpandedinfutureyears.

•Atthe8publicEPsites,atotalof4,474caseswereperformed,whichincluded3,136cardiacdeviceproceduresand1,061electrophysiologyprocedures.ThisauditincludesexpandedreportingaroundclinicalindicatorsforEPcases.

•ThisElectrophysiologyandPacingAuditidentifiedamedianwaittimeof81daysforcomplexablationprocedures,and33daysforelectiveICDimplants.

•Therewereatotalof11,723referralstooneofthe55publiccardiacrehabilitationservicesin2018.Mostreferrals(77%)followedanadmissionatapublichospitalinQueensland.

•ThevastmajorityofreferralstoCRwerecreatedwithinthreedaysofthepatientbeingdischargedfromhospital(95%),whileoverhalfofpatientswentontocompleteaninitialassessmentbyCRwithin28daysofdischarge(59%).

•Therewere4,878newreferralstoaheartfailuresupportservicein2018.Clinicalindicatorbenchmarkswereachievedfortimelyfollow-upofreferrals,andprescriptionofangiotensin-converting-enzymeinhibitor(ACEI)orangiotensinIIreceptorblockers(ARB)andappropriatebetablockersasperclinicalguidelines.


5 Acknowledgements and authorsThiscollaborativereportwasproducedbytheSCCIU,auditleadforQCORforandonbehalfoftheStatewideCardiacClinicalNetwork.

TheworkofQCORwouldnotbepossiblewithoutthecontinuedsupportandfundingfromClinicalExcellenceQueensland.Thispublicationdrawsontheexpertiseofmanyteamsandindividuals.Inparticular,theassistanceoftheStatisticalServicesBranch,HealthcareImprovementUnitandQueenslandAmbulanceServiceeachmakesignificantcontributionstoensurethesuccessoftheprogram.MetroNorthHospitalandHealthServicearealsorecognisedthroughtheirstakeinsupportingandhostingtheSCCIUoperationalteam.

Furthermore,thetirelessworkofclinicianswhocontributeandcollatequalitydata,aspartofprovidingqualitypatientcare,ensurescredibleanalysisandmonitoringofthestandardofcardiacservicesinQueensland.Thefollowingprovidedwritingassistancewiththisyear’sreport:

Interventional CardiologyDr Sugeet Baveja •TheTownsvilleHospitalDr Niranjan Gaikwad•ThePrinceCharlesHospitalDr Christopher Hammett•RoyalBrisbaneandWomen’sHospitalA/Prof Richard Lim•PrincessAlexandraHospitalDr Rohan Poulter•SunshineCoastUniversityHospitalA/Prof Atifur Rahman•GoldCoastUniversityHospitalDr Shantisagar Vaidya•MackayBaseHospitalDr Gregory Starmer (Chair)•CairnsHospital

Queensland Ambulance ServiceDr Tan Doan, PhDMr Brett Rogers

Cardiothoracic SurgeryDr Anil Prabhu•ThePrinceCharlesHospitalDr Andrie Stroebel•GoldCoastUniversityHospitalDr Morgan Windsor•RoyalBrisbaneandWomen’sHospital•ThePrinceCharlesHospitalDr Sumit Yadav•TheTownsvilleHospitalDr Christopher Cole (Chair)•PrincessAlexandraHospital

Electrophysiology and PacingMr John Betts•ThePrinceCharlesHospitalMr Anthony Brown•SunshineCoastUniversityHospitalMr Andrew Claughton•PrincessAlexandraHospitalDr Naresh Dayananda•SunshineCoastUniversityHospitalDr Russell Denman•ThePrinceCharlesHospitalMr Braden Dinham•GoldCoastUniversityHospitalMs Sanja Doneva•PrincessAlexandraHospitalMr Nathan Engstrom•TheTownsvilleHospitalMs Kellie Foder•RoyalBrisbaneandWomen’sHospitalDr Bobby John•TheTownsvilleHospitalDr Paul Martin•RoyalBrisbaneandWomen’sHospitalMs Sonya Naumann•RoyalBrisbaneandWomen’sHospitalDr Kevin Ng•CairnsHospitalDr Robert Park•GoldCoastUniversityHospitalA/Prof John Hill (Chair)•PrincessAlexandraHospital


Cardiac RehabilitationMs Michelle Aust•SunshineCoastUniversityHospitalMs Maura Barnden •MetroNorthHospitalandHealthServiceMr Gary Bennett•HealthContactCentreMs Jacqueline Cairns•CairnsHospitalMs Yvonne Martin•ChronicDiseaseBrisbaneSouthDr Johanne Neill•IpswichHospitalMs Samara Phillips•StatewideCardiacRehabilitationCoordinatorMs Deborah Snow•GoldCoastHospitalandHealthServiceMs Natalie Thomas•SouthWestHospitalandHealthServiceMr Stephen Woodruffe (Chair)•WestMoretonHospitalandHealthService

Heart Failure Support ServicesMs Kimberley Bardsley•QueenElizabethIIHospitalMs Tina Ha •PrincessAlexandraHospitalMs Helen Hannan•RockhamptonHospitalMs Annabel Hickey•StatewideHeartFailureServicesCoordinatorDr Rita Hwang, PhD•PrincessAlexandraHospitalMs Alicia McClurg•WestMoretonHospitalandHealthServiceDr Kevin Ng•CairnsHospitalMs Robyn Peters•PrincessAlexandraHospitalMs Serena Rofail •RoyalBrisbaneandWomen’sHospitalDr Yee Weng Wong•ThePrinceCharlesHospitalA/Prof John Atherton (Chair)•RoyalBrisbaneandWomen’sHospital

Statewide Cardiac Clinical Informatics UnitMr Michael MallouhiMr Marcus Prior Dr Ian Smith, PhDMr William Vollbon


6 Future plansContinualprogresswithexpandedanalysesandusesofclinicaldatahasbeenafocusforQCORin2018.Thisisevidentthroughnewreportelementsencompassingthoracicsurgeryandextendedexaminationofpatientsundergoingthrombolysisformyocardialinfarction.Similarly,obesityandcardiacsurgeryhavebeenexaminedandhaveunveiledkeyfindingsthatarehighlyrelevantgiventheincreasingincidenceofobesitywithinthegeneralpopulation.Intendingtoprovideclinicallyrelevantanalysis,thefutureworkofQCORisexciting.

TheutilisationoflinkagedataprovidedbyadministrativedatasetscontinuestoenableandassistQCORdatacollections.Thesedataenableinformationfromdifferentsourcestobebroughttogethertocreateanew,richerdataset.ExamplesoffutureopportunitiesfortheuseofsupplementarydatasetsaremedicationdetailfromdischargesummariesandpathologyinvestigationsundertakenwithinpublicQueenslandfacilities.Withaccesstotheseexpandeddatacollections,thereareopportunitiestobeseizedacrossmanyfrontsincludingenhancedriskadjustmentoptions,expandedclinicalindicatorprogramsandstreamlinedparticipationinnationalregistryactivities.Furthermore,thiswillenableefficienciesindatacollectionswhereelementsareeithernotavailableorpracticalforcollectionatthepoint-of-care,andtherebyreduceduplicationofentryacrossclinicalsystems.

OpportunitiesexisttobetterintegrateQCORclinicalapplicationswithenterprisesystemssuchastheacclaimedQueenslandHealthapplication,TheViewer.Itisenvisagedthatcardiacrehabilitationreferralsandassessmentformswillbeincorporatedwithinthepatientrecord,alongwithprocedurereportsgeneratedbytheupcomingQCORstructuralheartdiseaseapplication.ThesedevelopmentsaresettocomplementtheexistingreportsharingfunctionalitypresentwithintheQCORelectrophysiologysystem.Furtheropportunitieshavebeenflaggedacrosstheheartfailuresupportservicesandcardiothoracicsurgeryspacetoenhancetheseapplicationstomeetthebespokerequirementsoftheclinicalspecialtyareas.ByembracingopportunitiestosharevaluableclinicaldatakeptinvariousQCORsystems,investmentinQCORapplicationswillbefurtherrealisedandvalued.

Continualdevelopment,revision,andoptimisationofclinicalindicatorprogramsisessentialtotheongoingrelevanceoftheRegistry.QCORwillcontinuetocollaboratewithexpertsinallclinicaldomainstoexpandthescopeofourexistinganalyses.Thiswillbeundertakenwithaviewtomaintainandenhancethequalityofreportingandimprovethetimelinessandrelevanceoftheinformationprovidedforclinicalleads.Suchareaswherereportingwillbeenhancedfornextyear’sAnnualReportinclude:

•Timetoangiographyforpatientsreceivingthrombolysis

•Expandedradiationsafetyanalysesfordiagnosticandinterventionalcardiology

•Reviewofriskadjustmentmodelsforinterventionalcardiology

•EuroSCOREIIriskadjustmentforcardiacsurgerypatients

•MRAprescriptionratesforHFrEFpatients

•CRreferralsratesfollowingcardiacintervention

QCORisactivelyinvestigatingopportunitieswithinseveralareasincludingtheimplementationofnewpatient-reportedoutcomesandquality-of-lifemeasuresandrealisingfurtherefficienciesconcerningstatewideprocurementofmedicaldevices.NewareasofresearchandresearchpartnersandopportunitiestocontributetoworksunderwayacrossQueenslandHealth,andatanationallevel,arecontinuallybeingpursuedandengaged.


7 Facility profiles

7.2 The Townsville Hospital

Figure 2: The Townsville Hospital

•ReferralhospitalforCairnsandHinterlandandTorresandCapeHospitalandHealthServices,servingapopulationofapproximately280,000

•PublictertiarylevelinvasivecardiacservicesprovidedatCairnsHospitalinclude:

•Coronaryangiography

•Percutaneouscoronaryintervention

•Structuralheartdiseaseintervention

•ICD,CRTandpacemakerimplantation

•ReferralhospitalforTownsvilleandNorthWestHospitalandHealthServices,servingapopulationofapproximately295,000

•PublictertiarylevelinvasivecardiacservicesprovidedatTheTownsvilleHospitalinclude:




•Electrophysiology


•Cardiothoracicsurgery

7.1 Cairns Hospital

Figure 1: Cairns Hospital


7.4 Sunshine Coast University Hospital

Figure 4: Sunshine Coast University Hospital

•ReferralhospitalforMackayandWhitsundayregions,servingapopulationofapproximately182,000

•PublictertiarylevelinvasivecardiacservicesprovidedatMackayBaseHospitalinclude:



•Pacemakeranddefibrillatorimplants

•ReferralhospitalforSunshineCoastandWideBayHospitalandHealthServices,servingapopulationofapproximately563,000

•PublictertiarylevelinvasivecardiacservicesprovidedatSunshineCoastUniversityHospitalinclude:






7.3 Mackay Base Hospital

Figure 3: Mackay Base Hospital


7.6 Royal Brisbane and Women’s Hospital

Figure 6: Royal Brisbane and Women’s Hospital

•ReferralhospitalforMetroNorth,WideBayandCentralQueenslandHospitalandHealthServices,servingapopulationofapproximately900,000(sharedreferralbasewiththeRoyalBrisbaneandWomen’sHospital)

•PublictertiarylevelinvasivecardiacservicesprovidedatThePrinceCharlesHospitalinclude:







•Heart/lungtransplantunit

•Adultcongenitalheartdiseaseunit

•ReferralhospitalforMetroNorth,WideBayandCentralQueenslandHospitalandHealthServices,servingapopulationofapproximately900,000(sharedreferralbasewithThePrinceCharlesHospital)

•PublictertiarylevelinvasivecardiacservicesprovidedatTheRoyalBrisbaneandWomen’sHospitalinclude:






•Thoracicsurgery

7.5 The Prince Charles Hospital

Figure 5: The Prince Charles Hospital


7.8 Gold Coast University Hospital

Figure 8: Gold Coast University Hospital

•ReferralhospitalforMetroSouthandSouthWestHospitalandHealthServices,servingapopulationofapproximately1,000,000

•PublictertiarylevelinvasivecardiacservicesprovidedatthePrincessAlexandraHospitalinclude:







•ReferralHospitalforGoldCoastandnorthernNewSouthWalesregions,servingapopulationofapproximately700,000

•PublictertiarylevelinvasivecardiacservicesprovidedattheGoldCoastUniversityHospitalinclude:







7.7 Princess Alexandra Hospital

Figure 7: Princess Alexandra Hospital



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QCORAnnualReport2018 PageHF3

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1 Message from the Heart Failure Steering Committee Chair

ItismypleasuretoreleasethethirdannualreportonpatientsreferredtoHeartFailureSupportServices

(HFSS)inQueenslandHealth.Since2015wehavecollectedinformationonthecareandoutcomesof14,500

uniquepatientswithheartfailurewhowerereferredtooneofthemultidisciplinarysupportservicesofnurses

andalliedhealthacrossQueenslandHealth.

ClinicalperformanceindicatorsarebasedonpatientsreferredtoaHFSSinthe2018calendaryearandare

relatedtotimelinessoffollow-up,assessmentofleftventricularfunction,prescriptionofkeymedicationsand

betablockertitration.Theselectgroupofclinicalindicatorsisreflectiveofbestpracticeatastatewideand

locallevel.

Patientoutcomesincludeinformationaboutsurvival,re-hospitalisationanddaysaliveand0ut-of-hospitalat

astatewidelevel.Theoutcomeanalysisisbasedonthecohortfromthepreviousyeartoallowfortracking

outcomesoverthe12monthspostthehospitaldischargeassociatedwiththereferral.

Thisrichdatasetwouldnotexistwithoutthecommitmentofheartfailurenursesandotherhealthcare

providerstodatacollectionaspartofroutinepractice.Reportingofclinicalstandardsandoutcomesisin

thecontextofalargerongoingstatewidequalityimprovementprogramwherethereasonsforvariations

inpracticecanbeexploredandsystemsofcarecanbedevelopedtoensurethatpatientsreceivethebest

standardofcare.

Patientsandtheirfamiliesreferredtoheartfailuresupportservicesmanageamultitudeofsocial,emotional

andphysicalfactorsrelatedtothischroniccondition.Wehopethatthemonitoringofourclinicalpractice

isonesmall,butimportantcontributiontoensuringthatpatientsreceivethebestpossibleclinicalcareto

ultimatelylivelongerandachievethebestqualityoflife.

Associate Professor John Atherton Chair of the QCOR Heart Failure committee

PageHF4 QCORAnnualReport2018

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2 Key findingsCharacteristics of the 2018 cohort of referrals to a Heart Failure Support Service (HFSS)

•Themajorityofthe4,878referralswere:male(68%),non-Indigenous(94.7%),referredtoSouthEastQueenslandHFSS(85%);fromaninpatientsetting(70%);anddiagnosedwithHFrEF(80.2%).

•Medianageofreferralswas69yearsoldwith:malesyoungerthanfemales(68vs72years);AboriginalandTorresStraitIslanderyoungerthannon-Indigenouspatients(56vs70years);HFrEFpatientsyoungerthanHFpEF(68vs76years);andover20%aged80yearsormore.

Clinical indicator performance for 2018

•Mostindicatorsmetbenchmarksatastatewidelevelexceptforthereviewandtitrationofbetablockers(Clinicalindicator5a,b,c)(seeTable1).

•Thereisvariationinpracticewithmanyofthe21HFSSbelowbenchmarksforclinicalindicators1a(follow-upofinpatientreferralsintwoweeks)and5a,b,c(betablockerreviewandtitration).

•Prescribingofguidelinedirectedmedicationsmetbenchmarksforallsites.

Table 1: Summary of statewide clinical indicator performance

# Clinical indicator % referrals1a Follow-upofacutepatientswithin2weeks 78.51b Follow-upofnon-acutepatientswithin4weeks 82.4*2 Assessmentofleftventricularejectionfractionwithin2years 95.5*3a ACEI/ARB†prescriptionathospitaldischarge 92.1*3b ACEI/ARB†atfirstclinicalreview 91.0*4a Betablocker‡prescriptionathospitaldischarge 89.6*4b Betablocker‡prescriptionatfirstclinicalreview 91.3*5a Betablocker‡titrationstatusreviewatsixmonthspostreferral 66.75b Betablocker‡achievementofguidelinerecommendedtarget 32.45c Betablocker‡achievementofguidelinerecommendedtargetdoseormaximumtolerated

dose72.2

* Benchmarkmet(benchmarkis80%achievementexceptfor5bwhichis50%)

† Angiotensin-converting-enzymeinhibitor(ACEI)orangiotensinIIreceptorblockers(ARB)

‡ Bisoprolol,Carvedilol,Metoprololsustainedrelease,orNebivolol


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Patient outcomes

Patientoutcomesregardinghospitaluseanddeatharebasedon2017referralsfromaninpatientsourcetoallowfor12monthfollow-upfromtheindexhospitalisation.KeyfindingsaresummarisedinTable2.

Table 2: Summary of outcomes for patients referred from a hospital setting

# Measures post index hospitalisation* 30 days 1 year 1 All-causemortality 1.7% 14.3%2 a)All-causerehospitalisation 17.8% 57.0%

b)Heartfailurerehospitalisation 5.6% 24.2%3 Compositeall-causehospitalisationorall-causemortality 18.1% 58.1%4 Daysaliveandout-of-hospital† N/A 363mediandays‡

* Commencesfromdateofdischargeforindexadmission

† Asinglemeasureofmortality,readmissionsandlengthofstay

‡ Approximately55%ofpatientshadadditionaltimeinhospital

Recommendations

•MonitorMineralocorticoidreceptorantagonists(MRA)prescribinganduseofAngiotensinReceptor-NeprilysinInhibitors(ARNI)(underwayfor2019cohort).

•CollectinformationaboutHFwithassociatedvalvulardiseaseandrightheartfailure(underwayfor2019cohort).

•Recordreasonsfornotachievingtargetdoseofbetablockers(underwayfor2019cohort).

•Recordtheuseofcardiacimplantableelectronicdevices(CIED)(underdevelopmentfor2020cohort).

•Includeaclinicalindicatorrelatedtoexercisetraining.

•Furtherdevelopsystemsofcaretoimprovebetablockertitration.

•Collectadditionalvariablestoallowforriskadjustmentofpatientoutcomes.


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3 Participating sitesHeartfailuresupportservices(HFSS)consistofteamsofspecialisednurseswithmedicalsupport.Someservicesincludearangeofalliedhealth.Ofthe22HFSSinQueensland,21contributeddatatothisyear’sannualreport.Therewere23servicesin2017,buttwonursingservicesatThePrinceCharlesHospitalamalgamatedintoonein2018.ThelocationsandservicesofferedareshowninFigure1andTable3.

Table 3: Queensland Heart Failure Support Services (HFSS) facilities and acronyms

Hospital and Health Service (HHS) HFSS Facility AcronymCairnsandHinterland CairnsHospital CHCentralQueensland GladstoneHospital GLH

RockhamptonHospital RKHDarlingDowns ToowoombaHospital TWHGoldCoast GoldCoastCommunityHealth GCCHMackay MackayBaseHospital MBHMetroNorth CabooltureHospital CBH

RedcliffeHospital* RDHRoyalBrisbaneandWomen'sHospital RBWHThePrinceCharlesHospital TPCH

MetroSouth LoganHospital LGHMaterAdultHospital,Brisbane MTHBPrincessAlexandraHospital PAHQueenElizabethIIHospital QEIIRedlandHospital RLH

NorthWest MtIsaHospital MIHSunshineCoast GympieHospital GYH

SunshineCoastUniversityHospital SCUHTownsville TownsvilleHospital TTHWestMoreton IpswichCommunityHealth IPCHWideBay BundabergHospital† BNH

HerveyBayHospital(includesMaryborough) HBH

* Partialparticipation

† Didnotparticipate



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Rockhampton Hospital

Mackay Base Hospital

Maryborough Hospital

Townsville Hospital

Gladstone Hospital

Cairns Hospital

Hervey Bay Hospital

Royal Brisbane & Women's Hospital

Sunshine Coast University Hospital

Gold Coast Community Health

The Prince Charles Hospital

Toowoomba Hospital

Caboolture Hospital

Redcliffe Hospital

Redland Hospital

Gympie Hospital

Logan Hospital

Queen Elizabeth II Hospital

Princess Alexandra HospitalMater Adult Hospital

Ipswich Community Health

Mt Isa Hospital

Figure 1: Heart Failure Support Service locations


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Table 4: Components of Queensland Heart Failure Support Services

HFSS Disciplines Modes of service (telephone + ...)HHS Facility Nurse NP* Pharm† Physio

or AEP‡In-

patientNurse or MD clinics

Home visits

Groups Medical mentor§

Cairns and Hinterland CH Y Y – Y Y Y Y Y YCentral Queensland GLH Y – – Y Y – – Y Videoclinic

RKH Y Y Y Y Y Y – Y YDarling Downs TWH Y – Y – – Y Y – YGold Coast GCCH Y – Y Y Y Y Y Y YMackay MBH Y – – Y – Y – Y YMetro North CBH Y – Y – – Y – – Y

RDH Y – – – – – Y – YRBWH Y – Y Y Y Y – Y Y

TPCH Y Y Y Y Y Y – Y YMetro South LGH Y Y Y Y Y Y Y Y Y

MTHB Y Y – R Y Y Y – YPAH Y Y Y Y Y Y Y Y YQEII Y Y Y R Y Y Y – Y

RLH Y Y – Y Y Y Y Y YNorth West MIH Y Y – R Y Y Y – OutreachSunshine Coast GYH Y – – – Y Y Y Y Y

SCUH Y Y – R Y Y Y – YTownsville TTH Y Y Y R Y Y Y – YWest Moreton IPCH Y Y Y Y Y Y Y Y YWide Bay BNH Y – – R – – – – Y HBH Y Y – Y Y Y Y Y VideoclinicStatewide 100% 59% 50% 82% 77% 86% 68% 59% 100%

* Nursepractitionerwhocanprescribemedications

† Pharmacist

§ TheHFSShasacardiologistorgeneralphysicianmentor

‡ PhysiotherapistorAccreditedExercisePhysiologist

R Referralforexercisethatisroutinelyacceptedbyanotherprogramsuchascardiacorpulmonaryrehab


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4 New referralsIn2018,therewere4,878newreferralsreportedby21participatingHFSS.

4.1 Location of referrals

Table 5: Distribution of new referrals by HFSS location

Referrals per HHS n (%) Referrals per facility in each HHS n (%)CairnsandHinterland 156(3.2) CairnsHospital 156(3.9)CentralQueensland 201(4.2) GladstoneHospital 13(0.3)

RockhamptonHospital 188(3.9)DarlingDowns 100(2.1) ToowoombaHospital 100(2.1)GoldCoast 503(10.3) GoldCoastCommunityHealth 503(10.3)Mackay 85(1.7) MackayBaseHospital 85(1.7)MetroNorth 1,367(28.0) CabooltureHospital 187(3.8)

RedcliffeHospital 33(0.7)RoyalBrisbaneandWomen'sHospital 362(7.4)ThePrinceCharlesHospital 785(16.1)

MetroSouth 1,409(28.9) LoganHospital 362(7.4)MaterAdultHospital 92(1.9)PrincessAlexandraHospital 639(13.1)QueenElizabethIIHospital 133(2.7)RedlandHospital 183(3.8)

NorthWest 45(0.9) MtIsaHospital 45(0.9)SunshineCoast 488(10.0) GympieHospital 113(2.3)

SunshineCoastUniversityHospital 375(7.7)Townsville 184(3.8) TownsvilleHospital 184(3.8)WestMoreton 274(5.6) IpswichCommunityHealth 274(5.6)WideBay 66(1.4) HerveyBayHospital 66(1.4)Statewide 4,878 (100.0)


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Central Queensland201

Townsville184

Cairns and Hinterland156

Mackay85

Wide Bay66

North West45

MetroSouth1,409

MetroNorth1,367

Sunshine Coast488

GoldCoast503

West Moreton274

Darling Downs100

Figure 2: Regional distribution of new referrals


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4.2 Referral sourceMostreferralsoriginatedfromaninpatientsetting(70%).Fewreferralscamedirectlyfromprimarycare(3%)asmostreferralsflowtospecialtyoutpatientclinicsfordiagnosisandtreatmentoptimisationpriortoreferraltoaHFSS.

Table 6: Source of HFSS referral

HHS HFSS Inpatient n (%)

Outpatient n (%)

Another HFSS n (%)

Primary care n (%)

CairnsandHinterland CairnsHospital 96(61.5) 60(38.5) – –CentralQueensland GladstoneHospital 7(53.8) 1(7.7) 5(38.5) –

RockhamptonHospital 112(59.6) 59(31.4) 4(2.1) 13(6.9)DarlingDowns ToowoombaHospital 16(16.0) 74(74.0) 10(10.0) –GoldCoast GoldCoastCommunityHealth 374(74.4) 86(17.1) 21(4.2) 22(4.4)Mackay MackayBaseHospital 38(44.7) 45(52.9) 2(2.4) –MetroNorth CabooltureHospital 29(15.5) 56(29.9) 8(4.3) 94(50.3)

RedcliffeHospital 16(48.5) 14(42.4) 3(9.1) –RoyalBrisbaneandWomen'sHospital 271(74.9) 90(24.9) 1(0.3) –ThePrinceCharlesHospital 689(87.8) 91(11.6) 4(0.5) 1(0.1)

MetroSouth LoganHospital 261(72.1) 35(9.7) 59(16.3) 7(1.9)MaterAdultHospital 66(71.7) 26(28.3) – –PrincessAlexandraHospital 591(92.5) 44(6.9) 4(0.6) –QueenElizabethIIHospital 93(69.9) 24(18.0) 15(11.3) 1(0.8)RedlandHospital 87(47.5) 27(14.8) 67(36.6) 2(1.1)

NorthWest MtIsaHospital 16(35.6) 29(64.4) – –SunshineCoast GympieHospital 61(54.0) 14(12.4) 37(32.7) 1(0.9)

SunshineCoastUniversityHospital 307(81.9) 62(16.5) 6(1.6) –Townsville TownsvilleHospital 123(66.8) 60(32.6) 1(0.5) –WestMoreton IpswichCommunityHealth 152(55.5) 86(31.4) 34(12.4) 2(0.7)WideBay HerveyBayHospital 8(12.1) 14(21.2) 40(60.6) 4(6.1)Statewide 3,413 (70.0) 997 (20.4) 321 (6.6) 147 (3.0)


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5 Patient characteristics

5.1 AgeThestatewidemedianageofpatientsmanagedbyaHFSSwas69years.Themedianageofwomen(72years)wasfouryearsolderthanformen.Overone-third(34%)ofpatientswere75yearsofageandolder.

Male

10% 5% 0%

<40

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

≥85

Years

Female

0% 5% 10%

%oftotal(n=4,878)

Figure 3: Proportion of referrals to HFSS by gender and age group

Table 7: Median age of referrals by gender

HHS HFSS Male years

Female years

ALL years

CairnsandHinterland CairnsHospital 63 65 64CentralQueensland GladstoneHospital 59 74 67

RockhamptonHospital 69 66 68DarlingDowns ToowoombaHospital 65 59 63GoldCoast GoldCoastCommunityHealth 70 75 72Mackay MackayBaseHospital 63 68 65MetroNorth CabooltureHospital 71 70 71

RedcliffeHospital 80 78 78RoyalBrisbaneandWomen'sHospital 67 72 68ThePrinceCharlesHospital 68 72 70

MetroSouth LoganHospital 67 75 69MaterAdultHospital 66 75 70PrincessAlexandraHospital 68 71 69QueenElizabethIIHospital 67 76 70RedlandHospital 68 77 73

NorthWest MtIsaHospital 59 57 58SunshineCoast GympieHospital 76 75 76

SunshineCoastUniversityHospital 72 73 72Townsville TownsvilleHospital 65 66 65WestMoreton IpswichCommunityHealth 66 71 67WideBay HerveyBayHospital 71 74 71Statewide 68 72 69


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5.2 GenderThemajorityofpatientsweremale(68%),rangingfrom42%to81%acrossparticipatingsites.

Table 8: Number and proportion of referrals to HFSS by gender

HHS HFSS Male n (%)

Female n (%)

ALL n (%)

CairnsandHinterland CairnsHospital 116(74.4) 40(25.6) 156(100.0)CentralQueensland GladstoneHospital 10(76.9) 3(23.1) 13(100.0)

RockhamptonHospital 133(70.7) 55(29.3) 188(100.0)DarlingDowns ToowoombaHospital 81(81.0) 19(19.0) 100(100.0)GoldCoast GoldCoastCommunityHealth 347(69.0) 156(31.0) 503(100.0)Mackay MackayBaseHospital 56(65.9) 29(34.1) 85(100.0)MetroNorth CabooltureHospital 129(69.0) 58(31.0) 187(100.0)

RedcliffeHospital 14(42.4) 19(57.6) 33(100.0)RoyalBrisbaneandWomen'sHospital 251(69.3) 111(30.7) 362(100.0)ThePrinceCharlesHospital 507(64.6) 278(35.4) 785(100.0)

MetroSouth LoganHospital 247(68.2) 115(31.8) 362(100.0)MaterAdultHospital 57(62.0) 35(38.0) 92(100.0)PrincessAlexandraHospital 450(70.4) 189(29.6) 639(100.0)QueenElizabethIIHospital 81(60.9) 52(39.1) 133(100.0)RedlandHospital 109(59.6) 74(40.4) 183(100.0)

NorthWest MtIsaHospital 30(66.7) 15(33.3) 45(100.0)SunshineCoast GympieHospital 68(60.2) 45(39.8) 113(100.0)

SunshineCoastUniversityHospital 263(70.1) 112(29.9) 375(100.0)Townsville TownsvilleHospital 129(70.1) 55(29.9) 184(100.0)WestMoreton IpswichCommunityHealth 171(62.4) 103(37.6) 274(100.0)WideBay HerveyBayHospital 48(72.7) 18(27.3) 66(100.0)Statewide 3,297 (67.6) 1,581 (32.4) 4,878 (100.0)


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5.3 Aboriginal and Torres Strait Islander statusPatientsofidentifiedAboriginalandTorresStraitIslanderstatusmadeup5.5%ofallreferrals.Thenumberofreferrals(n=258)representeda40%increaseinreferralsfromthepreviousyear(n=185).AboriginalandTorresStraitIslanderpatientsweresignificantlyyoungerthanotherQueenslanders.Table9showsthattheproportionofAboriginalandTorresStraitIslanderreferralswashighestinMtIsa(47%),followedbyTownsville(23%)andCairns(20%).

Althoughasmallerproportionoftotalreferrals,almost40%ofallAboriginalandTorresStraitIslanderreferralsweretofacilitiesinthegreaterBrisbanearea(MetroNorthorMetroSouthHospitalandHealthServices).

Table 9: Proportion of site referrals identified Aboriginal and Torres Strait Islander

HHS Facility Indigenous n (%)

Non-Indigenous

n (%)

Not stated / unknown

n (%)CairnsandHinterland CairnsHospital 31(19.9) 125(80.1) –CentralQueensland GladstoneHospital 1(7.7) 12(92.3) –

RockhamptonHospital 20(10.6) 168(89.4) –DarlingDowns ToowoombaHospital 5(5.0) 94(94.0) 1(1.0)GoldCoast GoldCoastCommunityHealth 10(2.0) 488(97.0) 5(1.0)Mackay MackayBaseHospital 5(5.9) 80(94.1) –MetroNorth CabooltureHospital 7(3.7) 180(96.3) –

RedcliffeHospital – 33(100.0) –RoyalBrisbaneandWomen'sHospital 12(3.3) 349(96.4) 1(0.3)ThePrinceCharlesHospital 22(2.8) 763(97.2) –

MetroSouth LoganHospital 15(4.1) 347(95.9) –MaterAdultHospital 4(4.3) 86(93.5) 2(2.2)PrincessAlexandraHospital 32(5.0) 605(94.7) 2(0.3)QueenElizabethIIHospital 3(2.3) 130(97.7) –RedlandHospital 8(4.4) 175(95.6) –

NorthWest MtIsaHospital 21(46.7) 24(53.3) –SunshineCoast GympieHospital 1(0.9) 112(99.1) –

SunshineCoastUniversityHospital 7(1.9) 366(97.6) 2(0.5)Townsville TownsvilleHospital 42(22.8) 142(77.2) –WestMoreton IpswichCommunityHealth 12(4.4) 262(95.6) –WideBay HerveyBayHospital – 66(100.0) –Statewide 258 (5.3) 4,607 (94.4) 13 (0.3)


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Male

10% 5% 0%

<40

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

≥85

Years

Female

0% 5% 10%

Legend: ''

Indigenous male ''

Indigenous female Non Indigenous

%oftotalIndigenous(n=258)andtotalNon-Indigenous(n=4,607)

Excludesmissingdata(0.3%)

Figure 4: Proportion of all referrals by age group and Indigenous status

Table 10: Median patient age by gender and Indigenous status

HHS Total referrals n

Male years

Female years

ALL years

Indigenous 258 55 60 56Non-Indigenous 4,607 69 73 70ALL 4,865 68 72 69


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5.4 Classification of heart failure by left ventricular ejection fractionHeartfailurewithreducedejectionfraction(HFrEF)wasdefinedaspatientswithanejectionfraction(EF)equalorequivalentto50%attimeofdiagnosis.TheEFmayreturntonormalforsomepatientsbutstillrequireongoingmedicationstomanageHFrEF.27

ThedatacategorisedpatientsaspredominatelyHFrEForheartfailurewithpreservedejectionfraction(HFpEF).HFrEFwasattributedto80%ofpatientsinthe2018cohort.ThetablebelowshowstheratesofHFrEFandHFpEFaswellastherateswherethephenotypeisuncertain.Sixsiteshadmorethan20%ofreferralswithHFpEF.Fivesiteshadover95%ofreferralswithHFrEFand,ofthese,fourwereinFarNorthQueensland(Cairns,Townsville,MackayandMtIsa).

TherewasnosignificantgenderdifferencebetweenpatientswithHFpEF(males49.7%vsfemales50.3%).PatientswithHFrEFweremorelikelytobemale(71.7%)withamedianagewaseightyearsyoungerthanforHFpEF(68yearsvs76years).

Table 11: Proportion of patients by heart failure type

HHS HFSS HFrEF* n (%)

HFpEF† n (%)

Unsure/Unknown

n (%)CairnsandHinterland CairnsHospital 154(98.7) 1(0.6) 1(0.6)CentralQueensland GladstoneHospital 11(84.6) 1(7.7) 1(7.7)

RockhamptonHospital 157(83.5) 26(13.8) 5(2.7)DarlingDowns ToowoombaHospital 97(97.0) – 3(3.0)GoldCoast GoldCoastCommunityHealth 396(78.7) 96(19.1) 11(2.2)Mackay MackayBaseHospital 85(100.0) – –MetroNorth CabooltureHospital 138(73.8) 39(20.9) 10(5.3)

RedcliffeHospital 15(45.5) 9(27.3) 9(27.3)RoyalBrisbaneandWomen'sHospital 308(85.1) 50(13.8) 4(1.1)ThePrinceCharlesHospital 559(71.2) 184(23.4) 42(5.4)

MetroSouth LoganHospital 269(74.3) 85(23.5) 8(2.2)MaterAdultHospital 67(72.8) 14(15.2) 11(12.0)PrincessAlexandraHospital 550(86.1) 73(11.4) 16(2.5)QueenElizabethIIHospital 107(80.5) 18(13.5) 8(6.0)RedlandHospital 127(69.4) 41(22.4) 15(8.2)

NorthWest MtIsaHospital 43(95.6) 2(4.4) –SunshineCoast GympieHospital 56(49.6) 44(38.9) 13(11.5)

SunshineCoastUniversityHospital 320(85.3) 53(14.1) 2(0.5)Townsville TownsvilleHospital 171(92.9) 8(4.3) 5(2.7)WestMoreton IpswichCommunityHealth 222(81.0) 50(18.2) 2(0.7)WideBay HerveyBayHospital 58(87.9) 8(12.1) –Statewide 3,910 (80.2) 802 (16.4) 166 (3.4)

* Heartfailurewithreducedejectionfraction(LVEF<50%)

† Heartfailurewithpreservedejectionfraction(LVEF≥50%)


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Table 12: Summary of patient age, gender and Indigenous status by type of heart failure

HFrEF* HFpEF† Unsure/ Unknown

Number 3,910 802 166Age(medianyears) 68 76 77%male 71.7 49.7 2.0%Indigenous 4.6 3.6 0.1

Excludesmissingdata(3.5%)

* Heartfailurewithreducedejectionfraction

† Heartfailurewithpreservedejectionfraction

Male

10% 5% 0%

<40

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

≥85

Years

Female

0% 5% 10%

%oftotalwithHFrEF(n=3,910)

Figure 5: Proportion of HFrEF referrals by gender and age group

Male

10% 5% 0%

<40

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

≥85

Years

Female

0% 5% 10%

%oftotalwithHFpEF(n=802)

Figure 6: Proportion of HFpEF referrals by gender and age group


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5.5 Summary of patient characteristicsPatientcharacteristicsfromallreferralstoaHFSSisshownbelow.

Table 13: Summary of patient characteristics

Characteristic SummaryParticipatingHFSS 21Newreferrals 4,878ReferralsfromSouthEastQueensland 84.9%Referralsource: Inpatient 70.0% Outpatient 20.4% AnotherHFSS 6.6% Primarycare 3.0%Age(medianyears): All(median,rangebyservice) 69(58–78)years MalevsFemale 68vs72years ATSI*vsother 56vs70years HFrEF†vsHFpEF‡ 68vs76yearsAgegroup: 80yearsandover

20.7%

Males 67.6%ATSI* 5.3%HFrEF† 80.2%(57.5%male)HFpEF‡ 16.4%(8.1%male)

* AboriginalandTorresStraitIslander

† Heartfailurewithreducedejectionfraction

‡ Heartfailurewithpreservedejectionfraction


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6 Clinical indicatorsThenumberofclinicalindicatorscollectedwasintentionallylimitedtoallowpragmaticdataentryaspartofroutineclinicalpractice.ThefiveclinicalindicatorsselectedareshowninTable14.

Thetargetbenchmarkforallindicatorswassetat80%,exceptfor5b(betablockertitrationtoclinicalguidelinetargetdoseatsixmonths)wherethebenchmarkwassetat50%.Thelowerbenchmarkof50%acknowledgesthattargetdosesderivedfromclinicaltrialsmaybeinappropriateinclinicalpracticewherepatientsareoftenolderwithgreaterdiseaseseverityandassociatedcomorbiditiescomparedtopatientsrecruitedtolargedrugtrials.28

Table 14: Clinical indicators

Indicator # Process measures1 Firstclinicalreview:Timelinessoffollow-upbyaHFSSforinpatientandoutpatientreferrals

1a) Firstclinicalreviewwithin2weeksforinpatientreferrals1b) Firstclinicalreviewwithin4weeksfornon-acutereferrals

2 Leftventricularejectionfractionassessedwithin2yearsofreferraltoHFSS3 Prescriptionofangiotensin-converting-enzymeinhibitor(ACEI)orangiotensinIIreceptor

blockers(ARB)forpatientswithHFrEF3a) ACEI/ARBprescriptionathospitaldischarge3b) ACEI/ARBprescriptionattimeoffirstclinicalreview

4 PrescriptionofguidelinerecommendedbetablockersforHFrEF(Bisoprolol,Carvedilol,Metoprololsustainedrelease,orNebivolol)4a) Betablockerprescriptionathospitaldischarge4b) Betablockerprescriptionattimeoffirstclinicalreview

5 Betablockerreviewandtitration5a) Betablockertitrationreviewwithinsixmonthsoffirstclinicalreview5b) Betablockerclinicalguidelinetargetdoseachievedattimeoftitrationreview5c) Betablockerclinicalguidelinetargetormaximumtolerateddoseachievedattimeof titrationreview


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6.1 First clinical reviewTheHFSSreviewisdefinedasaclinical(ratherthanadministrative)interventionandcanbeconductedbyphone,clinicorhomevisit.Patientswereexcludediftheydied,werereferredtoanotherHFSS,declinedfollow-uporcouldnotbecontacted,aswellasotherreasonsoutlinedinTable15.

1a First clinical review by Heart Failure Support Service within 2 weeks of hospital discharge or date of referral if after discharge (for inpatient referrals).

Earlypostdischargefollow-upisrecommendedforpatientswithHFtomonitorsymptoms,provideeducationandsupportself-managementprinciples.Theappropriatetimeframechosenforthisinterventionwasreviewwithintwoweeksofhospitaldischargeordateofreferralafterrecenthospitalisation.

Ofthe3,413patientsreferredfromanacutesetting,79%receivedaclinicalreviewbyaHFSSwithintwoweeksofhospitaldischarge.

N/A N/A N/A N/A N/A

CH GLH RKH TWH GCCH MBH CBH RDH RBWH TPCH LGH MTBH PAH QEII RLH MIH GYH SCUH TTH IPCH HBH ALL0%

20%

40%

60%

80%

100%

N/A=Eligiblereferrals<20

Figure 7: Inpatients who received first HFSS clinical review within 2 weeks of hospital discharge

Table 15: Inpatients receiving first HFSS clinical review within 2 weeks of hospital discharge

n %Eligibleforanalysis 2,378 Achievedbenchmark 1,867 78.5 Benchmarknotachieved 511 21.5Ineligible 988 ReferredtoanotherHFSS 566 Patientdeclinedservice 126 Patientcouldnotbecontacted,livesoutofareaorrepeatedfailuretoattend 125 Patientdeceased 55 Referredtoanotherservice(e.g.cardiacrehabilitationorcommunitynursing) 47 HFnolongerprimeissue(palliativecare,highcarenursinghomeetc.) 43 Medicalfollow-uponly(GP,privateorpublicphysician) 19 HFSSatcapacityworkload 7 Otherreason 47Total inpatient referrals 3,413


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1b First Heart Failure Support Service clinical review within 4 weeks for non-acute referrals

Fornon-acutepatients,theStatewideHFSteeringCommitteedeterminedfourweeksfollowingreferraltobetherecommendedtimeframeforfirstclinicalreview.

Referralsfor1,465patientscamefromnon-acuteservices,ofwhich82%receivedaclinicalreviewwithinfourweeksofreferral.

N/A N/A


20%

40%

60%

80%

100%


Figure 8: Proportion of non-acute patients who received first HFSS clinical review within 4 weeks of referral

Table 16: Non-acute patients receiving first HFSS clinical review within 4 weeks of referral

n %Eligibleforanalysis 1,327 Achievedbenchmark 1,094 82.4 Benchmarknotachieved 233 17.6Ineligible 138 Patientcouldnotbecontacted,livesoutofareaorrepeatedfailuretoattend 42 Patientdeclinedservice 38 ReferredtoanotherHFSS 23 HFnolongerprimeissue(palliativecare,highcarenursinghomeetc.) 10 Patientdeceased 8 Medicalmanagementwithnosupportservice(notadvised) 4 Referredtoanotherservice(e.g.cardiacrehabilitationorcommunitynursing) 4 Otherreason 9Total non-acute patients 1,465


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6.2 Left ventricular ejection fraction (LVEF) assessed within 2 years of referral to HFSS

Australianclinicalguidelinesrecommendthatallpatientswithheartfailureshouldhaveanassessmentofleftventricularfunction.27In96%ofcases,LVEFwasassessedwithintwoyearsofreferraltoHFSS.

N/A


20%

40%

60%

80%

100%


Figure 9: Proportion of all patients who had LVEF assessed within two years of referral to HFSS

Table 17: Patients who had LVEF assessed within two years of referral

n %Eligibleforanalysis 4,878 Achievedbenchmark 4,657 95.5 Benchmarknotachieved 221 4.5Ineligible N/ATotal referrals 4,878


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6.3 Prescription of ACEI or ARB for patients with HFrEF Angiotensin-converting-enzymeinhibitor(ACEI)orangiotensinIIreceptorblockers(ARB)havebeenshowntoreducemortalityandmorbidityinpatientswithHFrEFandarerecommendedforallsymptomaticpatientsunlesscontraindicatedornottolerated.

3a ACEI or ARB prescription for HFrEF at hospital discharge

In2018,92%ofpatientsreferredtoaHFSSwereprescribedanACEIorARBtherapyonhospitaldischarge.

N/A N/A N/A N/A N/A N/A N/A


20%

40%

60%

80%

100%


Figure 10: Proportion of patients who were on ACEI or ARB therapy at time of hospital discharge

Table 18: Inpatients on ACEI or ARB at time of hospital discharge

n %Eligibleforanalysis 2,513Achievedbenchmark 2,315 92.1Benchmarknotachieved 198 7.9Ineligible 896NotHFrEF 655Documentedcontraindication* 156LVfunctionassessmentnotavailable 85Incompletedata 4Total inpatient referrals 3,413* AdversereactiontoACEIorARB,palliativeintenttotreatment,pregnancy,eGFR<30mL/min,severeaorticstenosis,renalartery

stenosis,serumpotassium>5.5mmol/L,symptomatichypotension


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3b ACEI or ARB prescription for HFrEF at time of first HFSS clinical review

Atthetimeoffirstclinicalreview,thetargetforprescriptionofACEIorARBwasmetfor91%ofpatients.

N/A N/A


20%

40%

60%

80%

100%


Figure 11: Proportion of patients on ACEI or ARB therapy at time of first clinical review by site

Table 19: Patients on an ACEI or ARB at first clinical review

n %Eligibleforanalysis 2,920 Achievedbenchmark 2,656 91.0 Benchmarknotachieved 264 9.0Ineligible 1895 NotHFrEF 663 ReferredtoanotherHFSS 589 Patientcouldnotbecontacted,livesoutofareaorrepeatedfailuretoattend 167 Patientdeclinedservice 164 Patientdeceased 63 Documentedcontraindication* 60 LVfunctionassessmentnotavailable 55 HFnolongerprimeissue(palliativecare,highcarenursinghomeetc.) 53 Referredtoanotherservice(e.g.cardiacrehabilitationorcommunitynursing) 51 Medicalfollow-uponly(GP,privateorpublicphysician) 23 HFSSatcapacityworkload 7 Otherreason 56Incompletedata 7Total referrals 4,878* AdversereactiontoACEIorARB,palliativeintenttotreatment,pregnancy,eGFR<30mL/min,severeaorticstenosis,renalartery

stenosis,serumpotassium>5.5mmol/L,symptomatichypotension


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6.4 Prescription of guideline recommended beta blockers for HFrEF GuidelinerecommendedbetablockershavebeenshowntoreducemortalityandmorbidityinpatientswithHFrEFandarerecommendedforallsymptomaticpatientsunlesscontraindicatedornottolerated.27Guidelinerecommendedbetablockersinclude:Bisoprolol,Carvedilol,Metoprololsustainedrelease,orNebivolol.Resultspertainonlytothesebetablockermedications.

4a Beta blocker prescription for HFrEF at time of hospital discharge

In2018,90%ofacutereferralswerereportedtobeonaguidelinerecommendedbetablockeratthetimeofdischargefromhospital.

N/A N/A N/A N/A N/A N/A N/A


20%

40%

60%

80%

100%

N/A=eligiblereferrals<20

Figure 12: Proportion of patients on guideline recommended beta blocker at hospital discharge by site

Table 20: Patients on guideline recommended beta blocker at hospital discharge

n %Eligibleforanalysis 2,598 Achievedbenchmark 2,328 89.6 Benchmarknotachieved 270 10.4Ineligible 811 NotHFrEF 655 LVfunctionassessmentnotavailable 85 Documentedcontraindication* 71Incompletedata 4Total inpatient referrals 3,413* Adversereactiontobetablocker,palliativeintenttotreatment,pregnancy,bradycardia(HR<50bpm),symptomatichypotension,

severeCOPD,asthma/reversibleairwaysdisease


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4b Beta blocker prescription for HFREF at time of first HFSS clinical review

In2018,91%ofreferralstoHFSSwerereportedtobeonaguidelinerecommendedbetablockeratthetimeoffirstclinicalreview.

N/A N/A


20%

40%

60%

80%

100%


Figure 13: Proportion of patients on guideline recommended beta blocker therapy at first clinical review by site

Table 21: Patients on guideline recommended beta blocker at first clinical review

n %Eligibleforanalysis 2,910 Achievedbenchmark 2,657 91.3 Benchmarknotachieved 253 8.7Ineligible 1961 NotHFrEF 663 ReferredtoanotherHFSS 589 Patientcouldnotbecontacted,livesoutofareaorrepeatedfailuretoattend 167 Patientdeclinedservice 164 Documentedcontraindication* 70 Patientdeceased 63 LVfunctionnotassessed 55 HFnolongerprimeissue(palliativecare,highcarenursinghomeetc.) 53 Referredtoanotherservice(e.g.cardiacrehabilitationorcommunitynursing) 51 Medicalfollow-uponly(GP,privateorpublicphysician) 23 HFSSatcapacityworkload 7 Otherreason 56Incompletedata 7Total referrals 4,878* Adversereactiontobetablocker,palliativeintenttotreatment,pregnancy,bradycardia(HR<50bpm),symptomatichypotension,



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6.5 Beta blocker titrationThisindicatorlooksattheprogressoftitrationofguidelinerecommendedbetablockersatsixmonthsfollowinghospitaldischargeorwhendeactivatedfromtheHFSS,whicheverissooner.ThetimeframeistakenfromthefirstclinicalreviewbyHFSS(usuallyatfourweeksfromreferralorhospitaldischarge).

Theindicatormeasuresthreecomponentsofbetablockertitrationatsixmonths,including:

a)Reviewoftitrationstatusundertaken,

b)Achievementoftargetdose,and

c)Achievementoftargetormaximumtolerateddose.

5a Beta blocker titration review conducted within six months of first HFSS clinical review

In2018,67%ofpatientsreceivedabeta-blockertitrationreviewatsixmonthsfromreferraloratthetimeofdeactivationfromtheHFSS(whicheverissooner).

N/A N/A


20%

40%

60%

80%

100%


Figure 14: Proportion of patients who had a beta blocker titration review conducted within six months by site


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Table 22: Patients who had a beta blocker titration review within six months

n %Eligibleforanalysis 1,449 Achievedbenchmark 967 66.7 Benchmarknotachieved 482 33.3Ineligible 1978 NotHFrEF 636 Patientontargetdoseatthetimeofreferral 590 Patientdeclinedservice 111 Patientcouldnotbecontacted,livesoutofareaorrepeatedfailuretoattend 95 Medicalfollow-uponly(GP,privateorpublicphysician) 90 ReferredtoanotherHFSS 89 Documentedcontraindication* 84 Patientdeceased 78 LVfunctionnotassessed 74 HFnolongerprimeissue(palliativecare,highcarenursinghomeetc.) 27 Patientatmaxtolerateddose 20 Referredtoanotherservice(e.g.cardiacrehabilitationorcommunitynursing) 5 Otherreason 79Incompletedata 48Total 3,475* Adversereactiontobetablocker,palliativeintenttotreatment,pregnancy,bradycardia(HR<50bpm),symptomatichypotension,



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5b Beta blocker clinical guideline target dose achieved at time of titration review

Thebenchmarkfortargetdosebetablockertitrationwassetlowerthantheotherindicatorsat50%.Thislowerbenchmarkistoaccommodatedifferencesinpatientsrecruitedtoclinicaltrialscomparedtopatientspresentinginclinicalpracticewhoareolderwithmorecomorbidities.

Guidelinerecommendedtargetdosewasachievedfor32%ofreferralswithin6months,withonlyonesiteexceedingthebenchmark(seeFigure15).

Dailytargetdosesare:

•Carvedilol50–100mg

•Metoprololsustainedrelease190mg

•Bisoprolol10mg

•Nebivolol10mg

N/A N/A


20%

40%

60%

80%

100%


Figure 15: Proportion of patients who achieved target beta blocker dose at time of titration review by site

Table 23: Patients who achieved target beta blocker dose at time of titration review

n %Eligibleforanalysis 1,449 Achievedbenchmark 1,046 72.2 Benchmarknotachieved 403 27.8Ineligible N/ATotal titration reviews conducted 1,449


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5c Beta blocker titration clinical guideline target or maximum tolerated dose achieved at time of titration review

Maximumtolerateddoseofbetablockersisbasedonamedicaljudgementbalancingtheharmandbenefitofup-titration.Thenumberofpatientsreachingthetargetdoseormaximumtolerateddoseofguidelinerecommendedbetablockermedicationbythetimeofthetitrationreviewwas72%.


20%

40%

60%

80%

100%

N/A N/A


Figure 16: Proportion of patients who achieved target beta blocker dose or maximum tolerated dose at time of titration review

Table 24: Patients who achieved target or maximum tolerated beta blocker dose at time of titration review

n %Eligibleforanalysis 1,449 Achievedbenchmark 470 32.4 Benchmarknotachieved 979 67.6Ineligible N/ATotal titration reviews conducted 1,449


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6.6 Summary of clinical indicators

Table 25: Summary of clinical process indicator performance by site

Clinical Indicator achievement %HHS HFSS 1a 1b 2 3a 3b 4a 4b 5a 5b 5cCairnsandHinterland CairnsHospital 75 93 99 91 94 97 95 99 34 79CentralQueensland GladstoneHospital – – – – – – – – – –

RockhamptonHospital 54 76 98 88 81 85 78 38 26 66DarlingDowns ToowoombaHospital – 63 97 – 100 – 97 56 42 78GoldCoast GoldCoastCommunityHealth 91 93 95 87 87 86 88 66 29 72Mackay MackayBaseHospital 81 81 100 97 92 97 94 77 27 79MetroNorth CabooltureHospital 41 70 95 – 90 – 92 86 11 82

RedcliffeHospital – – 73 – – – – – – –RoyalBrisbaneandWomen'sHospital 75 93 98 93 93 89 93 32 28 74ThePrinceCharlesHospital 71 63 94 92 89 94 94 73 40 85

MetroSouth LoganHospital 75 90 97 89 87 92 94 81 25 74MaterAdultHospital 88 62 92 95 100 88 96 100 61 61PrincessAlexandraHospital 89 38 96 94 93 84 88 61 31 62QueenElizabethIIHospital 57 59 92 91 90 91 92 41 35 80RedlandHospital 93 100 90 93 95 92 84 68 28 59

NorthWest MtIsaHospital – 77 98 – 94 – 89 86 49 80SunshineCoast GympieHospital 82 94 81 – 89 – 96 94 26 87

SunshineCoastUniversityHospital 95 91 99 97 94 94 94 84 38 89Townsville TownsvilleHospital 98 98 96 95 94 92 95 96 34 69WestMoreton IpswichCommunityHealth 72 94 97 92 93 83 88 44 29 46WideBay HerveyBayHospital – 98 100 – 98 – 97 39 47 82Statewide 79 82 96 92 91 90 91 67 32 72Legend:

1a Follow-upofacutepatientswithin2weeks(Benchmark:80%)

1b Follow-upofnon-acutepatientswithin4weeks(Benchmark:80%)

2 Assessmentofleftventricularejectionfractionwithin2years(Benchmark:80%)

3a Angiotensin-converting-enzymeinhibitororangiotensinIIreceptorblockersprescriptionathospitaldischarge(Benchmark:80%)

3b Angiotensin-converting-enzymeinhibitororangiotensinIIreceptorblockersprescriptionatfirstclinicalreview(Benchmark:80%)

4a Guidelinerecommendedbetablockerprescriptionathospitaldischarge(Benchmark:80%)

4b Guidelinerecommendedbetablockerprescriptionatfirstclinicalreview(Benchmark:80%)

5a Betablockertitrationstatusreviewatsixmonthspostreferral(Benchmark:80%)

5b Betablockersachievementofguidelinerecommendedtargetdose(Benchmark:50%)

5c Betablockersachievementofguidelinerecommendedtargetdoseormaximumtolerateddose(Benchmark:80%)


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7 Patient outcomesHeartfailurehospitalisationsareassociatedwithsubsequentincreasedriskofmortalityandrecurrenthospitalisation.SupportfrommultidisciplinaryHFdiseasemanagementprogrammes(suchasQueensland’sHFSS)andadherencetorecommendedtherapiesareassociatedwithimprovedpost-dischargeoutcomes.

7.1 MethodsThisanalysisusedthepreviouslyreported2017patientcohortfromtheQCORHFSSHEROregistrytoexaminetheearly(30day)andoneyearclinicaloutcomes(rehospitalisationandmortality)amongpatientsreferredtoHFSS.ThiswasperformedusingprobabilisticdatalinkagefromtheQueenslandHospitalAdmittedPatientDataCollection(QHAPDC)andQueenslandRegistryofBirths,DeathsandMarriages.

Forthisreport,onlyHFSSreferralsinitiatedduringaninpatientencounterfor2017wereincluded.WherepatientshadmultiplereferralstoaHFSSduringthisperiod,theearliestadmissionofthecalendaryearwasconsideredastheindexadmission(whichmaynotbethefirsttimethatapatienthasbeenhospitalisedwithheartfailure).

Eligibilitycriteriaforthemortalityandreadmissionanalysiscohortwereappliedatthetimeoftheindexadmission.Theeligibilitystatusfordaysaliveandoutofhospital(DAOH)analysiswasreviewedatallsubsequentadmissionsover12monthstoexcludepatientswhoweretransferredtoprivatehospitalsorinterstate.

ThepatientoutcomeindicatorsofinterestaresummarisedinTable26.SurvivalcurveswereconstructedusingtheKaplan–Meiermethodandcumulativeincidencefunction(CIF)wasusedtoestimatetheriskofall-causeandHFrelatedre-hospitalisationtoaccountforthecompetingriskofdeath.

DAOHwascalculatedtoreflecttheburdenofrecurrenthospitalisation,hospitallengthofstayanddeath,andwasexpressedasbothmedianvalueswith25thand75thpercentilesandmeanvalues.Categoricalvariablesweresummarisedasfrequenciesandpercentages.

Table 26: Patient outcome indicators

Indicator # Measure1 All-causemortalitywithinoneyearafterindexhospitalisationdischarge2 Rehospitalisationwithinoneyearafterindexhospitalisationdischarge

a) All-causerehospitalisationb) Heartfailurerehospitalisation*

3 Compositeofall-causehospitalisationorall-causemortalitywithinoneyearafterindexhospitalisationdischarge

4 Daysaliveandoutofhospitalwithinoneyearofindexhospitaldischargedate

* ICD10AMcodes:E87.7,I13.0,I13.2,I25.5,I42.0,I42.1,I42.2,I42.5,I42.6,I42.7,I42.8,I42.9,I46.0,I46.1,I46.9,I50,J81,J90,R18,R57.0,R60.1


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7.2 FindingsIn2017therewere3,207inpatientreferrals,andofthese96%weresuccessfullylinkedviatheQHAPDC.Therewere460patientswhowereineligibleforreadmissionandmortalityanalysisforvariousreasonsshowninTable27.Afurther52patients(1.7%)didnothavecompletefollowupof365daystoallowDAOHanalysis.

Table 27: Eligibility criteria for patient outcome indicators

n %Total 2017 inpatient referrals 3,207 100Ineligibleatindexadmission Duplicatepatientrecord 218 6.8 Diedduringindexadmission 21 0.7 NotaQueenslandresident 53 1.7 Indexadmissionisnotovernight 26 0.8 Transferredtoprivatehospital 25 0.8 Nolinkagedataavailable 117 3.7Included in readmission and mortality analysis 2,747 85.7Ineligibleatsubsequentadmissionover1year Transferredtoprivatehospital 47 1.5 MovedoutsideofQueensland 5 0.2Included in days alive and out of hospital analysis 2,695 84.0

7.2.1 All-cause mortality

AmongpatientsreferredtoHFSSduringaninpatientencounter,the30dayandoneyearunadjustedall-causemortalityrateswere1.7%and14.3%.TheKaplan-Meiersurvivalanalysesbelow(Figures17–19)suggestthatolderagewasassociatedwithincreasedmortalityratesatalltimepointsandparticularlyat12months.

Table 28: Cumulative all-cause unadjusted mortality rate from 30 to 365 days after index discharge date

30 days n (%)

90 days n (%)

180 days n (%)

365 days n (%)

Totaldeathsidentified 46(1.7) 122(4.4) 218(7.9) 393(14.3) Diedduringsubsequentadmission* 22(0.8) 48(1.7) 78(2.8) 147(5.4) Allotherdeaths 24(0.9) 74(2.7) 140(5.1) 246(9.0)Total at risk 2,701 (98.3) 2,625 (95.6) 2,529 (92.1) 2,354 (85.7)* DataavailableforQueenslandpublichospitalsonlyremovedfullstop


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Table 29: Cumulative all-cause unadjusted mortality by patient characteristic

Total patients n

30 days n (%)

90 days n (%)

180 days n (%)

365 days n (%)

Gender Male 1,777 22(1.2) 66(3.7) 135(7.6) 246(13.8) Female 970 24(2.5) 56(5.8) 83(8.6) 147(15.2)Age group <65years 939 5(0.5) 18(1.9) 33(3.5) 57(6.1) 65–74years 710 11(1.5) 22(3.1) 48(6.8) 88(12.4) ≥75years 1,098 30(2.7) 82(7.5) 137(12.5) 248(22.6)Heart failure phenotype HFrEF 2,098 32(1.5) 84(4.0) 142(6.8) 257(12.2) HFpEF 519 8(1.5) 25(4.8) 57(11.0) 109(21.0) Missing/unsure 130 6(4.6) 13(10.0) 19(14.6) 27(20.8)

0 90 180 270 360Days

0%

20%

40%

60%

80%

100%

Figure 17: Heart failure survival by gender

0 90 180 270 360Days

0%

20%

40%

60%

80%

100%

Figure 18: Heart failure survival by age group

0 90 180 270 360Days

0%

20%

40%

60%

80%

100%

Figure 19: Heart failure survival by phenotype


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7.2.2 All-cause and heart failure rehospitalisation

Cumulativeincidencecurvesforall-causeandHFhospitalisationareshowninFigure20and21.Ofthe2,747eligiblepatientsreferredtoHFSSduring2017,theunadjustedrateofall-causehospitalisationwas17.8%at30days,increasingto57.0%at365days.HospitalisationsrelatingtoHF(asidentifiedbydischargediagnosiscoding)were5.6%and24.2%at30daysandoneyearrespectively.

Theoverallriskofhospitalisationordeathwithin12monthsposttheindexadmissionwas58.1%(Figure22).Almostone-thirdofpatientsreferredtoaHFSSwererehospitalisedatleasttwotimesinthesubsequent12months(Table30).

Table 30: Number of rehospitalisations per patient over one year since discharge

Total in 1 year All-cause n (%)

Heart failure n (%)

0 1,222(44.5) 2,134(77.7)1 637(23.2) 387(14.1)2 370(13.5) 137(5.0)3 196(7.1) 47(1.7)4 134(4.9) 20(0.7)≥5 188(6.8) 22(0.8)

0 90 180 270 360Days

0%

20%

40%

60%

80%

100%

17.8%

33.1%

43.8%

57.0%

Figure 20: Cumulative incidence of all-cause rehospitalisation

0 90 180 270 360Days

0%

20%

40%

60%

80%

100%

11.3%16.7%

24.2%

5.6%

Figure 21: Cumulative incidence of heart failure rehospitalisation

0 90 180 270 360Days

0%

20%

40%

60%

80%

100%

18.1%

33.9%

44.8%

58.0%

Figure 22: Cumulative incidence of all-cause rehospitalisation or death


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7.2.3 Days alive and out of hospital

Daysaliveandoutofhospital(DAOH)incorporatesmortalityandallhospitalisations(includinglengthofhospitalstay)withinoneyearofdischarge.Thissinglemeasuredemonstratesthepostdischargetimealiveandnotinhospitalasacombinedmeasure.

Almost43%ofpatientssurvivedmorethanayearwithoutrehospitalisationwithamedianof363daysforthewholegroup.ThemeanDAOHwas328.3,whichequatestoover98,000dayslostduetodeathorhospitalisationover12monthsin2,695patients.

TheboxandwhiskerplotsinFigure24illustratethedistributionofscoresfordifferentcharacteristics.Themedianofthedataiscloseto365formostcategories(theboxshowsthemiddle50%ofscores).Thewhiskersstretchingtotherightillustratethatmanypatientsspentsubsequenttimeinhospitalordied.TheDAOHwasmuchlowerforpatientswhowereover75yearsoldorhadanuncertainheartfailurephenotypeorHFpEFcomparedtoothercharacteristics.

0–28 28–56 56–84 84–112 112–140 140–168 168–196 196–224 224–252 252–280 280–308 308–336 336–364 3650%

10%

20%

30%

40%

50%

Days

Figure 23: Days alive and out of hospital within one year after hospital discharge

Table 31: Days alive and out of hospital within one year of discharge by patient characteristics

Characteristic Detail n Mean Median (IQR)Sex Male 1,750 330.3 364(351–365)

Female 945 324.5 362(347–365)Agegroup <65 929 346.8 365(359–365)

65–74 699 333.1 363(350–365)≥75 1,067 309.0 359(322–365)

HFphenotype HFrEF 2,068 333.4 364(353–365)HFpEF 500 313.2 358(328–365)Missing/unsure 127 303.3 359(312–365)

Statewide 2,695 328.3 363 (349–365)


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Characteristic Detail

Sex Male

Female

Age group <65

65–74

≥75

HF phenotype HFrEF

HFpEF

Missing/unsure

0 30 60 90 120 150 180 210 240 270 300 330 360

ALL –

Legend: 25th to 50th percentile 50th to 75th percentile Median (50th percentile) 1.5 x IQR to 25th percentile Outlier

Mean,medianandinterquartilerange(IQR)aregivenindays

Figure 24: Days alive and out of hospital within one year of discharge by patient characteristics


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8 ConclusionsThisannualreportcapturedinformationonpatientreferralsto21QueenslandHeartFailureSupportServices.

ReferralsforAboriginalandTorresStraitIslanderpatientsgrewby40%thisyearcomparativeto2017.ThereasonforthischangemaybeduetobetteridentificationofIndigenousstatus.WhileimprovedcardiovasculardiseasesurvivalofIndigenousQueenslanders29maycontributetoanincreaseintheprevalenceofheartfailure,itisunlikelythatthiswouldhappenedsuddenlyinoneyear.

Aswithpreviousreports,mostreferralstoHFSSareforpatientswithHFrEF,eventhoughevidencesuggeststhatpatientswithHFpEFalsobenefitfromsupport.BarrierstoHFpEFreferrals,couldbeduepoorcasefindingandlimitedresourcestogrowcaseloads.FurthercharacterisationofheartfailurebeyondHFrEFandHFpEFwouldassistinunderstandingthetreatmentneedsandoutcomesofthecohort.

AsprescribingpracticesforACEI/ARBandbetablockershaveremainedconsistentlyhighoverthethreeyearsofreporting,itmaybetimelytomeasuretheuseofotheragentswherethereislikelytoberoomforimprovement.Furthermore,informationisneededaboutnon-pharmacologicalcareincludingcardiacimplantableelectronicdevices(CIED)andexercisetraining.

Monitoringbetablockeruseover6monthscontinuestobeachallengewithmostsites(despiteactiveeducationandsupport)notachievingbenchmarks.Whilsttherateoftitrationtomaximaltolerateddoseapproachesthe80%benchmark,thereisconcernthat33%ofpatientsdidnothaveabetablockerreviewandthatthedefinitionof“maximaltolerated”reliesonclinicaljudgement.Astargetdoseisamoreobjectivemeasureitwouldhelpinplanningifreasonsfornotachievingtargetinthe6monthtimeframewereprovided.

Patientoutcomescontinuetoillustratetheburdenofthediseasewith55%ofpatientsspendingadditionaltimeinhospitalaftertheirindexadmission.UnadjustedoutcomesfortheHFpEFphenotypearesignificantlypoorercomparedtotheHFrEF.Thecurrentdatasetdoesnotallowriskadjustmentoftheoutcomesthuslimitingtheabilitytodiscernindependentassociations.Asunmeasuredconfoundersmayinfluencetheobservedassociations,comparisonsofpatientoutcomesacrossindividualsiteswasintentionallyavoided.


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9 RecommendationsUpdatedatacollectionto:

•Introduceanewclinicalindicatorregardingmineralocorticoidreceptorantagonists(MRA)prescription(underwayfor2019cohort).

•ExpandclinicalindicatorsforprescriptionofACEIorARBtoincludeangiotensinreceptor-neprilysininhibitors(ARNI)asanacceptablealternative(underwayfor2019cohort).

•FurthercharacteriseHFphenotypestoincludeHFwithassociatedvalvulardiseaseandrightheartfailure(underwayfor2019cohort).

•Providereasonsfornotachievingbetablockertargetdosein6months(underwayfor2019cohort).

•Recordtheuseofcardiacimplantableelectronicdevices(CIED)(underdevelopmentfor2020cohort).

•Includeaclinicalindicatorrelatedtoexercisetraining.

•Collectcovariatestoallowforrisk-adjustmentofpatientoutcomes.

Qualityimprovementactivities:

•Developsystemsofcaretoimprovethereviewandtitrationofmedicationsposthospitaldischargeandtoaddressvariancesinclinicalperformance.

Newrecommendations:

•SupportHFSStoimprovebetablockertitrationby:promotingnurseandpharmacistfacilitationoftitration(whenmanagedbyGP);advocatingformorepharmacyandnursepractitionerinvolvementincare;andprovidingsystemstotrackpatientsundertitrationandforgeneratingtitrationplans.

•Introducetargetednon-pharmacologicalinterventionsknowntoimprovequalityoflifeandrelievesymptoms;forexample,exercisetherapyandpsycho-socialsupport.

•Measureoutcomesforallpatientsregardlessofreferralsource(i.e.foroutpatientaswellasinpatientreferrals).

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ReferencesHeart Failure Support Services Audit

27. Atherton,J.,Branagan,M.,Sindone,A.,Abhayaratna,W.,Driscoll,A.,Pasquale,C.D.,…Thomas,L.(2018).TheNationalHeartFoundationofAustraliaandCardiacSocietyofAustraliaandNewZealandGuidelinesforthePrevention,Detection,andManagementofChronicHeartFailureinAustralia2018.Heart, Lung and Circulation, 27(10),1123-208.

28. Atherton,J.J.,&Hickey,A.(2017).ExpertComment:IsMedicationTitrationinHeartFailuretooComplex?Cardiac Failure Review, 03(01),25.

29. TheStateofQueensland(QueenslandHealth).(2019).Closing the Gap Performance Report 2018: Aboriginal and Torres Strait Islander Health Branch.Brisbane,QLD.Retrievedfrom:https://www.health.qld.gov.au/__data/assets/pdf_file/0034/857662/CTG_report_2018v2.pdf

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Glossary6MWT SixMinuteWalkTestACC AmericanCollegeofCardiologyACEI AngiotensinConvertingEnzymeInhibitorACOR AustralasianCardiacOutcomesRegistryACS AcuteCoronarySyndromesANZSCTSAustralianandNewZealandSocietyofCardiac

andThoracicSurgeonsAQoL AssessmentofQualityofLifeARB AngiotensinIIReceptorBlockerARNI AngiotensinReceptor-NeprilysinInhibitorsASD AtrialSeptalDefectATSI AboriginalandTorresStraitAV AtrioventricularAVNRT AtrioventricularNodalRe-entryTachycardiaBCIS BritishCardiovascularInterventionSocietyBiV BiventricularBMI BodyMassIndexBMS BareMetalStentBNH BundabergHospitalBSSLTX BilateralSequentialSingleLungTransplantBVS BioresorbableVascularScaffoldCABG CoronaryArteryBypassGraftCAD CoronaryArteryDiseaseCBH CabooltureHospitalCCL CardiacCatheterLaboratoryCH CairnsHospitalCHF CongestiveHeartFailureCI ClinicalIndicatorCR CardiacRehabilitationCRT CardiacResynchronisationTherapyCS CardiacSurgeryCV CardiovascularCVA CerebrovascularAccidentDAOH DaysAliveandOutofHospitalDES DrugElutingStentDOSA DayOfSurgeryAdmissionDSWI DeepSternalWoundInfectionECG 12leadElectrocardiographECMO ExtracorporealMembraneOxygenationED EmergencyDepartmenteGFR EstimatedGlomerularFiltrationRateEP ElectrophysiologyFdECG FirstDiagnosticElectrocardiographFTR FailureToRescueGAD GeneralizedAnxietyDisorderGCCH GoldCoastCommunityHealthGCUH GoldCoastUniversityHospitalGLH GladstoneHospitalGP GeneralPractitionerGYH GympieHospitalHBH HerveyBayHospital(includesMaryborough)HF HeartFailureHFpEF HeartFailurewithPreservedEjectionFractionHFrEF HeartFailurewithReducedEjectionFractionHFSS HeartFailureSupportServiceHHS HospitalandHealthServiceHOCM HypertrophicObstructiveCardiomyopathyHSQ HealthSupportQueenslandIC InterventionalCardiology

ICD ImplantableCardioverterDefibrillatorIHT Inter-hospitalTransferIPCH IpswichCommunityHealthLAA LeftAtrialAppendageLAD LeftAnteriorDescendingArteryLCX CircumflexArteryLGH LoganHospitalLOS LengthOfStayLV LeftVentricleLVEF LeftVentricularEjectionFractionLVOT LeftVentricularOutflowTractMBH MackayBaseHospitalMI MyocardialInfarctionMIH MtIsaHospitalMRA MineralocorticoidReceptorAntagonistsMTHB MaterAdultHospital,BrisbaneNCDR TheNationalCardiovascularDataRegistryNOAC Non-VitaminKAntagonistOralAnticoagulantsNP NursePractitionerNRBC Non-RedBloodCellsNSTEMI NonST-ElevationMyocardialInfarctionOR OddsRatioPAH PrincessAlexandraHospitalPAPVD PartialAnomalousPulmonaryVenousDrainagePCI PercutaneousCoronaryInterventionPDA PatentDuctusArteriosusPFO PatentForamenOvalePHQ PatientHealthQuestionairreQAS QueenslandAmbulanceServiceQCOR QueenslandCardiacOutcomesRegistryQEII QueenElizabethIIHospitalQH QueenslandHealthQHAPDC QueenslandHospitalAdmittedPatientData

CollectionRBC RedBloodCellsRBWH RoyalBrisbaneandWomen’sHospitalRCA RightCoronaryArteryRDH RedcliffeHospitalRHD RheumaticHeartDiseaseRKH RockhamptonHospitalRLH RedlandHospitalSCCIU StatewideCardiacClinicalInformaticsUnitSCCN StatewideCardiacClinicalNetworkSCUH SunshineCoastUniversityHospitalSHD StructuralHeartDiseaseSTEMI ST-ElevationMyocardialInfarctionSTS SocietyofThoracicSurgeryTAVR TranscatheterAorticValveReplacementTMVR TranscatheterMitralValveReplacementTNM Tumour,LymphNode,MetastasesTPCH ThePrinceCharlesHospitalTPVR TranscatheterPulmonaryValveReplacementTTH TheTownsvilleHospitalTWH ToowoombaHospitalVAD VentricularAssistDeviceVATS Video-AssistedThoracicSurgeryVCOR VictorianCardiacOutcomesRegistryVF VentricularFibrillationVSD VentricularSeptalDefect

Pageiii QCORAnnualReport2018

Ongoing initiativesWhilstcontinuallyrefiningandimprovingdatacollectionandreportingpracticesforthebenefitofpublicfacilities,QCORisalsobeginningtheinvestigationofamethodtocollectandanalyseclinicaldataforprivatehealthcarefacilities.Followinginterestfromvariousprivateproviders,QCORislookingtoextenditsqualityandsafetyfocustoaccommodatetherequirementsofthesefacilities.ItisanticipatedthatQCORwillprovidearoleinthedeliveryofreportsandbenchmarkingactivitieswhilstalsoactingasaconduittothevariousnationalregistriesinexistenceanddevelopment.

CardiacoutreachcontinuestoexpandinQueenslandwithformalisedandnewlyfundedserviceshavingcommencedbetweenCairnsandHinterlandandTorresandCapeHospitalandHealthServiceintendingtoprovidecardiaccareinmanyofthesecommunitiesforthefirsttime.ServiceswillcommenceinJanuary2020betweenTownsvilleandNorthWest.Theforwardplanfortherolloutofthismodelacrossthestatehasbeendevelopedinpartnershipwithconsumersandclinicians.Anewsystem,theQCOROutreachapplicationhasbeendevelopedtotrackactivity,serviceprovisionandpatientoutcomes.Thisground-updevelopmentspecificallyforcardiacoutreachfinishedtestingandgoesliveforuseinlate2019.

TheQCORStructuralHeartDiseasemoduleiscurrentlyinadvancedstagesofdevelopmentwithwiderdeploymentexpectedin2020.ThisQCORmodulehasbeendevelopedtoprovidesuperiorprocedurereportingcapabilitiesforstructuralheartdiseaseinterventions,deviceclosure,andpercutaneousvalvereplacementandrepairprocedures.Itwillenableparticipationinnationalqualityandsafetyactivitiesfortranscatheteraorticvalvereplacementaswellasallowclinicianstoutilisetheapplicationforcollectingpreandpost-proceduraldatainunprecedenteddetail.Theapplicationhasbeenthroughrigoroustestingwithusertrainingandfurtherenhancementsplannedforthenearfuture.

TheECGFlashinitiativeoftheSCCNhascontinuedtobeimplementedatseveralsitesthroughout2018and2019.Deploymentofhardwaretospokesiteshasbeenviaastagedapproachwithuptakebeingvariedbasedonlocalsiteworkloadandworkforce.IntegrationofECGFlashwithworkflowwithinhubsitescontinuestoevolvewithsitesnowtakingtheinitiativetoembraceandfeedbacktositesregardingtheappropriateuseofthesystem.Analysisoftheutilityofthesystemisbeginningtotakeplacewithafocusonclinicalefficacyandbenefit.ItisanticipatedthatQCORwillbeabletosupportthisnewinitiativethroughprocedurallinkageandoutcomemonitoringforthesubsetofpatientswhoseclinicalpathutilisedECGFlashandwentontosubsequentinvestigationormanagement.

OpportunitiesforparticipationintheformativestagesofnationalregistriesandinitiativeshavebeenembracedbyQueenslandclinicians.TheseimportantinitiativeswhichareinvariousstageofdevelopmentwillbecriticaltothefutureofclinicalregistriesinAustralia.Itisanticipatedthatwithfurtherinvolvementfromlocalstakeholdersthattheseentitieswillevolveintorelevantandusefultoolsforpatient-centredreportingandoutcomes.

QCORAnnualReport2018 Pageiv

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Documents

Clinical Excellence Queensland · 6.3 Prescription of ACEI or ARB for patients with HFrEF HF 23 6.4 Prescription of guideline recommended beta blockers for HFrEF HF 25 6.5 Beta blocker