How are you taking part in this consultation?

You will not be able to change how you comment later.

You must be signed in to answer questions

    The content on this page is not current guidance and is only for the purposes of the consultation process.

    Equality and health inequalities assessment (EHIA): GID-IND10334: Heart failure: ejection fraction category (newly diagnosed)

    Closed for comments This consultation ended on at   Request commenting lead permission

    STAGE 1. Consultation

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

    A new indicator is proposed to improve the recording of heart failure phenotype. 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:

    1. Some ethnic minority groups may receive less frequent cardiovascular diagnostic testing or specialist referrals, which could lead to under-recording of ejection fraction in certain ethnic groups.

    2. Differences in diagnostic infrastructure and access to cardiology services across regions (for example, urban vs rural areas) might have an impact on data collection.

    3. Older patients may face challenges in accessing diagnostic services or may have comorbidities that complicate assessment and recording of ejection fraction. This might lead to under-recording in elderly populations or misclassification of heart failure subtype.


    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 need for better data collection in primary care for coding heart failure phenotype. Clear referral processes, cultural awareness training, and better community engagement could help reduce disparities.

    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?

    Age UK and HEART UK are registered stakeholders.

    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?

    1. Testing in CPRD Aurum suggests that 42% of all people with heart failure have a recording of ejection fraction category (reduced, mildly reduced or preserved) (Nakao 2023, Sundaram 2022). Is focusing on new diagnoses a pragmatic approach? 

    2. Are there specific clinical or practical challenges in recording ejection fraction consistently? 

    3. What unintended consequences might arise from focusing on ejection fraction documentation? 

    Completed by lead analyst: Shalmali Deshpande

    Date: 19/06/2025

    Approved by NICE quality assurance lead: Craig Grime

    Date: 19/06/2025