Document resource
Background HFpEF represents approximately half of heart failure cases, yet evidence-based prescribing rates remain suboptimal in UK primary care. The NHS Advice and Guidance (A&G) model allows GPs to access specialist input without formal referral, but its effectiveness in improving HFpEF management is unknown. We evaluated whether cardiology A&G recommendations translate into improved evidence-based prescribing in primary care.Methods We conducted a retrospective service evaluation of 164 patients diagnosed with HFpEF at a U.K secondary care centre via the A&G pathway between February 2023-2024. We extracted demographics, diagnostic timeframes and medication data pre- and post-specialist review from electronic health records. McNemar’s test analysed changes in prescribing rates. Follow-up data assessed clinical outcomes including hospitalisation and mortality.Results Mean patient age was 79.9±7.5 years, 60% female, with high comorbidity burden (47% had ≥3 co-morbidities). Median time to echocardiography was 41 days and to diagnosis 50 days, approximating NICE guidelines. Following specialist recommendations, SGLT2 inhibitor prescribing increased from 4.3% to 61.6% (p<0.001), exceeding the 40% national average. MRA prescribing rose from 3.1% to 13.4% (p<0.001) and loop diuretics from 24.4% to 47.6% (p<0.001). Over median 18.5-month follow-up, 13.4% required cardiovascular hospitalization and 6.2% died, with mortality correlating with comorbidity burden rather than prescribing patterns.Conclusions The A&G model effectively translates specialist recommendations into improved evidence-based HFpEF prescribing in primary care, substantially exceeding national benchmarks whilst maintaining patient safety. This pathway represents a pragmatic, resource-efficient approach to optimizing HFpEF management within NHS capacity constraints.