Advice from NICE aims to improve commissioning of services for people with chronic heart failure and for people who need cardiac rehabilitation
NICE has today (31 October 2011) published guides for commissioners on services for people with chronic heart failure and services for people who need cardiac rehabilitation. The guide on the commissioning of services for people who need cardiac rehabilitation updates and replaces the previous NICE guide on commissioning a cardiac rehabilitation service, published in 2008, and together with the guide on the commissioning of services for people with chronic heart failure reflects the recent NICE quality standards for chronic heart failure and changes to recommendations within NICE clinical guideline CG108 on chronic heart failure. The advice, which is aligned with the outcomes and indicators specified in the NHS Outcomes Framework, is the latest in NICE's series of good practice guides to support commissioners in designing services to improve outcomes for patients and to help the NHS make better use of its resources.
Heart failure, which is associated with significant morbidity and mortality, is a complex clinical syndrome of symptoms - such as breathlessness and fatigue - and signs - such as fluid retention -that suggest the efficiency of the heart is impaired. The most common cause of heart failure in the UK is coronary artery disease (CHD), with many patients having suffered a myocardial infarction (heart attack) in the past.
Heart failure affects about 900,000 people in the UK at any one time, with almost the same number again who have damaged hearts but as yet no symptoms - and that number is increasing as a result of improved prognosis of coronary artery disease, ageing of the population and better treatments for heart failure. Heart failure accounts for a total of 1 million inpatient bed days - 2% of all NHS inpatient bed-days - and 5% of all emergency medical admissions to hospital. Hospital admissions because of heart failure are projected to rise by 50% over the next 25 years - largely as a result of the ageing population.
Cardiac rehabilitation is a structured set of services that enables people with CHD to have the best possible help (physical, psychological and social) to preserve or resume their optimal functioning in society. The National service framework for coronary heart disease established a goal that every hospital should ensure that more than 85% of people discharged from hospital with a primary diagnosis of acute MI or after coronary revascularisation are offered cardiac rehabilitation. It is also recommended in NICE clinical guideline CG94 on unstable angina and NSTEMI. NICE clinical guideline CG108 on chronic heart failure published in 2010 made a new recommendation supporting cardiac rehabilitation for people with chronic heart failure.
Illustrated with examples from the NHS, the NICE guides for commissioners identify the potential benefits, including those specified in the NHS Outcomes Framework, of an integrated approach to commissioning high quality care for people with chronic heart failure and people who need cardiac rehabilitation. Each guide signposts and provides topic-specific information on key clinical and service-related issues to consider during the commissioning process. They also offer an indicative benchmark of activity to help commissioners determine the level of service needed locally. Within each commissioning guide, an interactive tool provides data for local comparison against the benchmark and resources to estimate and inform the cost of commissioning intentions.
Commissioning cardiac rehabilitation and chronic heart failure services sits within the wider commissioning strategy for cardiovascular disease and long-term conditions. The guides therefore recommend that commissioners should consider the whole care pathway for cardiovascular disease and long-term conditions when commissioning these services. They should also consider how cardiac rehabilitation services and services for people with chronic heart failure are integrated across health and social care, voluntary and community services.
Dr Hugh McIntyre, Consultant Physician and chair of the Topic Expert Group which developed the NICE quality standard for chronic heart failure, said: "Heart failure is increasing in prevalence. This is partly due to reduced mortality as a result of major advances in treatment but also because of ageing of the population, and longer survival of people with conditions that can directly lead on to heart failure such as hypertension, ischaemic heart disease and atrial fibrillation. As a consequence the demand for services for people with chronic heart failure and for people who need cardiac rehabilitation will increase. The NICE guides for commissioners are designed to facilitate the commissioning of evidence-based care, providing valuable advice and guidance throughout the commissioning cycle. The purpose of these guides is to ensure that high quality services are commissioned, not only to improve outcomes for people with chronic heart failure and people who need cardiac rehabilitation, but also to enable commissioners, through service redesign, to release or realign resources towards treatments and interventions that add value."
While the guides for commissioners draw on existing NICE recommendations, they do not constitute formal NICE guidance and are intended as tools to help the NHS improve patient care through effective commissioning of services.
Notes to Editors
About the guides for commissioners
1. Commissioning in the NHS is the process by which health and care service providers decide how to spend their money most effectively to meet the needs of the population. It is a complex process with responsibilities ranging from assessing population needs and prioritising health outcomes, to procuring products and services and managing service providers.
2. The NICE guide for commissioners on services for people with chronic heart failure is available on the NICE website at http://www.nice.org.uk/usingguidance/commissioningguides/chronicheartfailure/chronicheartfailure.jsp
3. The NICE guide for commissioners on cardiac rehabilitation services is available on the NICE website at http://www.nice.org.uk/usingguidance/commissioningguides/cardiacrehabilitation/cardiacrehabilitation.jsp
4. The NICE commissioning guide on services for people with chronic heart failure draws on the ‘Chronic heart failure: management of chronic heart failure in adults in primary and secondary care' NICE clinical guideline 108 (2010), ‘Depression in adults with a chronic physical health problem: treatment and management' NICE clinical guideline 91 (2009), NICE pathways on chronic heart failure and depression and NICE quality standards on chronic heart failure and depression in adults
5. The NICE commissioning guide on cardiac rehabilitation services draws on NICE clinical guideline CG48 ‘MI: secondary prevention - secondary prevention in primary and secondary care for patients following a myocardial infarction', NICE clinical guideline CG94 ‘unstable angina and NSTEMI: the early management of unstable angina and non-ST-segment-elevation myocardial infarction', NICE clinical guideline CG108 ‘chronic heart failure: management of chronic heart failure in adults in primary and secondary care' and NICE quality standard on Chronic Heart Failure
6. Details of all the NICE guides for commissioners published to date can be found on the NICE website at http://www.nice.org.uk/usingguidance/commissioningguides/bytopic.jsp
7. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.
8. NICE produces guidance in three areas of health:
- public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
- health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
- clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS
9. NICE produces standards for patient care:
- quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
- Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients
10. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.
This page was last updated: 28 October 2011