Paschalis Theodoros, Jones Carol
Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, UK.
Department of General Practice, Creffield Medical Group, Colchester, UK.
J Family Med Prim Care. 2020 Feb 28;9(2):1098-1102. doi: 10.4103/jfmpc.jfmpc_917_19. eCollection 2020 Feb.
Diabetes mellitus is a known risk factor for heart failure (HF); nevertheless, many HF patients remain undiagnosed. The National Institute for Health and Care Excellence in England updated their HF guidelines in 2018, replacing the use of fasting plasma glucose with glycated hemoglobin (HbA1c), in suspected HF investigation. This audit aimed to assess this update's uptake at a general practice partnership in Colchester, England.
The audit cycle consisted of a two-round electronic record search, for approximately 29,000 patients registered at the partnership. From November 1, 2017 to November 1, 2018 for the first round and from November 1, 2018 to March 6, 2019 for the second round, patients who had their NT pro-brain natriuretic peptide levels measured for the initial investigation of suspected HF were included in the study. Interventions put in place after the first round included an oral presentation and an illustrated guide for the general practitioners (GPs).
One hundred and ten patients, 19 in cycle 1 and 91 in cycle 2, were identified and included in the analysis. At the first round, only 31.6% of the patients had their HbA1c level measured, while 36.8% had no diabetic investigation done. At the second round, the percentage of patients who had their HbA1c level assessed increased to 59.3%. A decrease from 36.8% of patients without diabetic status assessment to 20% was observed.
Lack of awareness among GPs regarding this guideline update was identified and simple interventions achieved an increase in the guideline's uptake. Regular and complete audit cycles can help GPs adhere to up-to-date guidelines. Primary care can help other organizations such as pathology laboratories keep up to date with guidelines, while primary care technology can be amended in-house to help adherence to new guidelines. We recommend the National UK Heart Failure Audit considers auditing the use of HbA1c testing in inpatients investigated for new HF.
糖尿病是已知的心力衰竭（HF）风险因素；然而，许多HF患者仍未被诊断出来。英国国家卫生与临床优化研究所于2018年更新了其HF指南，在疑似HF调查中用糖化血红蛋白（HbA1c）取代了空腹血糖的检测。本次审核旨在评估英国科尔切斯特一家全科医疗合作伙伴对此更新内容的采用情况。
审核周期包括两轮电子记录搜索，涉及该合作伙伴登记的约29,000名患者。第一轮为2017年11月1日至2018年11月1日，第二轮为2018年11月1日至2019年3月6日，对因疑似HF进行初步调查而检测N末端脑钠肽前体水平的患者纳入研究。第一轮后采取的干预措施包括为全科医生（GP）进行口头报告和提供图文指南。
共识别出110名患者，其中第1周期19名，第2周期91名，并纳入分析。在第一轮时，仅31.6%的患者检测了HbA1c水平，而36.8%的患者未进行糖尿病相关检查。在第二轮时，检测HbA1c水平的患者百分比增至59.3%。未进行糖尿病状态评估的患者比例从36.8%降至20%。
发现全科医生对该指南更新缺乏认识，简单的干预措施使指南采用率有所提高。定期且完整的审核周期有助于全科医生遵循最新指南。初级保健可帮助其他机构（如病理实验室）跟上指南更新，同时可在内部修改初级保健技术以帮助遵循新指南。我们建议英国国家心力衰竭审核考虑对因新发HF接受调查的住院患者中HbA1c检测的使用情况进行审核。
