Equality and health inequalities assessment (EHIA): GID-IND10332: Heart failure: 4 pillars (HFrEF)

What approaches have been used to identify potential equality and health inequalities issues during indicator development?

It is proposed that two existing indicators on heart failure medication will be combined, to align with the update on the clinical guideline. Equality and health inequality issues have been identified through the existing EHIA on NICE's guideline on chronic heart failure in adults: diagnosis and management (2018, updated 2025).

What potential equality and health inequalities issues have been identified during indicator development?

Some potential equality and health inequalities concerns are:

How have the committee's considerations of equality and health inequalities issues identified in 1.2 been reflected in the indicator?

The committee discussed the option to exclude people with moderate or severe frailty from the indicator denominator as intensive treatment may not be suitable for some people who are unable to tolerate the medications. However, the committee noted that this could unfairly disadvantage people who could benefit from the additional treatment and optimisation. Instead, the indicator notes the need to consider personalised care adjustments or exception codes for those unable to tolerate all four treatments.

Could any indicators potentially increase inequalities?

Focusing only on people with reduced ejection fraction, instead of people with left ventricular systolic dysfunction (as described by current indicators) could increase inequalities for people diagnosed with heart failure prior to more recent approaches of identifying ejection fraction category.

Based on the equality and health inequalities issues identified in 1.2 do you have representation from relevant stakeholder groups for the indicator consultation process, including groups who are known to be affected by these issues? If not, what plans are in place to ensure relevant stakeholders are represented and included?

Registered national stakeholders include Age UK, British Cardiovascular Society, British Medical Association, Carers UK, HEART UK, Mind, Office for Health Improvement and Disparities, Primary Care Cardiovascular Society and Royal College of General Practitioners.

Has it been proposed to exclude any population groups from coverage by the indicator? If yes, could these exclusions further impact on people affected by any equality and health inequalities issues identified?

No populations have been excluded.

What questions will you ask at the stakeholder consultation about the impact of the indicator on equality and health inequalities?

Do you think there is potential for differential impact (in respect of age, disability, gender and gender reassignment, pregnancy and maternity, race, religion or belief, and sexual orientation)? If so, please state whether this is adverse or positive and for which group.

If you think any of these indicators may have an adverse impact in different groups in the community, can you suggest how the indicator might be delivered differently to different groups to reduce health inequalities?

Are there any barriers to prescribing all four recommended drug classes in routine care?

Do stakeholders agree that, in line with the guideline, the indicator should only focus on people with heart failure and recorded reduced ejection fraction?