Chronic heart failure quality standard

1. People presenting in primary care with suspected heart failure and previous myocardial infarction are referred urgently, to have specialist assessment including echocardiography within 2 weeks.

2. People presenting in primary care with suspected heart failure without previous myocardial infarction have their serum natriuretic peptides measured.

3. People referred for specialist assessment including echocardiography, either because of suspected heart failure and previous myocardial infarction or suspected heart failure and high serum natriuretic peptide levels, are seen by a specialist and have an echocardiogram within 2 weeks of referral.

4. People referred for specialist assessment including echocardiography because of suspected heart failure and intermediate serum natriuretic peptide levels are seen by a specialist and have an echocardiogram within 6 weeks of referral.

5. People with chronic heart failure are offered personalised information, education, support and opportunities for discussion throughout their care to help them understand their condition and be involved in its management, if they wish.

6. People with chronic heart failure are cared for by a multidisciplinary heart failure team led by a specialist and consisting of professionals with appropriate competencies from primary and secondary care, and are given a single point of contact for the team.

7. People with chronic heart failure due to left ventricular systolic dysfunction are offered angiotensin-converting enzyme inhibitors (or angiotensin II receptor antagonists licensed for heart failure if there are intolerable side effects with angiotensin-converting enzyme inhibitors) and beta-blockers licensed for heart failure, which are gradually increased up to the optimal tolerated or target dose with monitoring after each increase.

8. People with stable chronic heart failure and no precluding condition or device are offered a supervised group exercise-based cardiac rehabilitation programme that includes education and psychological support.

9. People with stable chronic heart failure receive a clinical assessment at least every 6 months, including a review of medication and measurement of renal function.

10. People admitted to hospital because of heart failure have a personalised management plan that is shared with them, their carer(s) and their GP.

11. People admitted to hospital because of heart failure receive input to their management plan from a multidisciplinary heart failure team.

12. People admitted to hospital because of heart failure are discharged only when stable and receive a clinical assessment from a member of the multidisciplinary heart failure team within 2 weeks of discharge.

13. People with moderate to severe chronic heart failure, and their carer(s), have access to a specialist in heart failure and a palliative care service.

Full CHF quality standard (PDF format)

This NICE quality standard defines clinical best practice within this topic area. It provides specific, concise quality statements, measures and audience descriptors to provide patients and the public, health and social care professionals, commissioners and service providers with definitions of high-quality care.

Rationale for developing this quality standard

Heart failure is a complex clinical syndrome in which the heart's ability to pump blood around the body is reduced. It is caused by structural or functional abnormalities of the heart. The most common cause of heart failure in the UK is coronary heart disease, and many patients have had a myocardial infarction in the past.

Patients with chronic heart failure often experience a poor quality of life; symptoms include breathlessness, fatigue and ankle swelling and over one third of patients experience severe and prolonged depressive illness. Heart failure has a poor prognosis: 30-40% of patients diagnosed with heart failure die within one year; thereafter the mortality is less than 10% per year. Heart failure accounts for 2% of all NHS inpatient bed-days and 5% of all emergency medical admissions to hospital. Readmissions are common: about 1 in 4 patients are readmitted in three months.

Effective multidisciplinary specialist services for people with chronic heart failure can have a positive effect on patients' life expectancy and quality of life and evidence suggests they can help to reduce recurrent hospital stays by 30-50%. This quality standard describes markers of high-quality, cost-effective care that, when delivered collectively, should contribute to improving the effectiveness, safety and experience of care for people with chronic heart failure.

Scope of the quality standard

This quality standard covers the assessment, diagnosis and management of chronic heart failure in adults.

Chronic heart failure quality statements

The quality standard for chronic heart failure requires that services should be commissioned from and coordinated across all relevant agencies encompassing the whole chronic heart failure care pathway. An integrated approach to provision of services is fundamental to the delivery of high-quality care to adults with chronic heart failure.

Download the chronic heart failure areas of care map to see the quality statements mapped against the areas of chronic heart failure care.

Policy context

NHS Improvement Programme and NHS End of life care programme (2010) End of life care in heart failure. Available from www.improvement.nhs.uk/heart

NHS Heart Improvement Programme (2005) Heart failure: a quick guide to quality commissioning across the whole pathway of care. Available from www.improvement.nhs.uk/heart/

Department of Health (2003) Developing services for heart failure. Available from www.dh.gov.uk

Department of Health (2000) Coronary heart disease: national service framework for coronary heart disease. Available from www.dh.gov.uk

Key development sources

Chronic heart failure: management of chronic heart failure in adults in primary and secondary care. NICE clinical guideline 108 (2010; NHS Evidence accredited source). Available from www.nice.org.uk/guidance/CG108

Development team

Fergus Macbeth
Director

Nick Baillie
Associate Director

Tim Stokes
Consultant Clinical Adviser

Craig Grime
Lead Analyst

Topic Expert Group: chronic heart failure

Consultation feedback

Consultation on the chronic heart failure quality standard took place from 19 January to 16 February 2011. In total, 338 stakeholders were contacted during consultation. All eligible comments were reviewed by the Topic Expert Group and the standard was updated accordingly.

Chronic heart failure consultation report

Implementation support materials

Publication partners

Many organisations share NICE's commitment to improve quality by making it clear what quality care is for patients and the public, health and social care professionals, commissioners and service providers.

So that these standards reach the widest possible audience, some of the organisations who have been involved in the development process, and who endorse the chronic heart failure quality standard, have become partners in its publication.

These organisations are:

British Association for Nursing in Cardiovascular Care
British Cardiovascular Society
British Heart Foundation
British Society of Heart Failure
The Cardiomyopathy Association
NHS Improvement - Heart Improvement
Primary Care Cardiac Society
Royal College of Nursing
Royal College of Physicians