Determining local service levels for a heart failure service for the management of chronic heart failure

Benchmarks for a standard population

Available data suggest that the standard benchmark rate for new referrals into a heart failure service is 0.5%, or 500 per 100,000 population, aged 45 years or older per year. Around 1.8%, or 1800 per 100,000 population, aged 45 years or older, are expected to have confirmed heart failure, and may require support from a heart failure service. Approximately 40% of the English population is aged 45 years or older.

For a standard primary care trust population of 250,000 (around 100,000 people are aged 45 years or older) the average number of people requiring a new referral to a heart failure service would be 500 per year (or 0.5% of the population aged 45 years or older). A standard primary care trust population is expected to have around 1800 people with a confirmed diagnosis of heart failure (1.8% of the population aged 45 years or older) who may also require support from a heart failure service at any one time.

For an average practice with a list size of 10,000 (around 4000 are aged 45 years or older) the average number of people requiring a new referral to a heart failure service would be 20 per year (0.5% of the population aged 45 years or older). An average sized practice is expected to have around 70 people with a confirmed diagnosis of heart failure (1.8% of the population aged 45 years or older) that may also require support from a heart failure service at any one time.

Not all people with suspected heart failure who are referred for specialist assessment or echocardiography are subsequently diagnosed with heart failure. It has been estimated that approximately 40% or around 0.2% of the population aged 45 years or older, are likely to have the diagnosis of heart failure confirmed. See figure 1 for details.

A proportion of people with diagnosed heart failure will be at high risk of emergency admission and readmissions. This group of patients is likely to benefit from the coordinated care of a heart failure service and this could impact on the local service provision required. The PARR (Patients at risk of re-hospitalisation) tool can support commissioners to identify the local high risk population and plan service requirements.

This service is likely to fall under the programme budgeting category 210A (problems of circulation - coronary heart disease) and may also fall under the programme budgeting category 210C (problems of cardiac rhythm - coronary heart disease).

Examine the assumptions used in estimating these figures.

Use the heart failure service commissioning and benchmarking tool to determine the level of service that might be needed locally and to calculate the cost of commissioning the service using the indicative benchmark and/or your own local data.

Further information

Sources of further information to help you in assessing local health needs and reducing health inequalities include:

• Annex A of the ‘Commissioning framework for health and well-being' outlines the process and data needed to undertake a joint strategic needs assessment.
• Department of Health ‘Delivering quality and value - focus on benchmarking'.
• NICE ‘Health equity audit - learning from practice briefing'.
• ‘Delivering the 18 week patient pathway: 18 week commissioning pathways'.
• The ‘No delays achiever' provides access to service improvement tools aimed at reducing time between referral and treatment.
• The ‘Disease management information toolkit (DMIT)' is a good-practice tool for decision-makers, commissioners and deliverers of care for people with long term conditions, which presents data on conditions that contribute to high numbers of emergency bed days. It models the effects of possible interventions that may be commissioned at a local level and helps users to consider the likely impact of commissioning options.
• Disease prevalence models produced by the Association of Public Health Observatories (APHO) provide PCT-level prevalence estimates for hypertension and coronary heart disease.
• PRIMIS+ provides support to general practices on information management, recording for, and analysis of, data quality, plus a comparative analysis service focused on key clinical topics.