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Chronic heart failure: management of chronic heart failure in adults in primary and secondary care [CG108]

Measuring the use of this guidance

Recommendation: 1.1.1.1

Take a careful and detailed history, and perform a clinical examination and tests to confirm the presence of heart failure

What was measured: Proportion of patients with heart failure who received an echo.
Data collection end: March 2014
91%
Data collection end: March 2015
91%
Area covered: National
Source: National Institute for Cardiovascular Outcomes Research. National Heart Failure Audit.

What was measured: Proportion of patients with heart failure who received an ECG.
Data collection end: March 2014
99%
Data collection end: March 2015
99.7%
Area covered: National
Source: National Institute for Cardiovascular Outcomes Research. National Heart Failure Audit.


Recommendation: 1.1.1.2

Refer patients with suspected heart failure and previous myocardial infarction (MI) urgently, to have transthoracic Doppler 2D echocardiography and specialist assessment within 2 weeks. [new 2010]

What was measured: HF002: The percentage of patients with a diagnosis of heart failure (diagnosed on or after 1 April 2006) which has been confirmed by an echocardiogram or by specialist assessment 3 months before or 12 months after entering on to the register.
Data collection end: March 2015
90.9%
Data collection end: March 2016
90.85%
Data collection end: March 2017
91.11%
Area covered: National
Source: Health and Social Care Information Centre. Quality and Outcomes Framework.


Recommendation: 1.2.2.2

Offer both angiotensin-converting enzyme (ACE) inhibitors and beta-blockers licensed for heart failure to all patients with heart failure due to left ventricular systolic dysfunction. Use clinical judgement when deciding which drug to start first.

What was measured: Proportion of patients with heart failure who were prescribed an ACE and/or ARB, beta blocker and mineralocorticoid receptor antagonists (MRA).
Data collection end: March 2014
41%
Area covered: National
Source: National Institute for Cardiovascular Outcomes Research. National Heart Failure Audit.

What was measured: In those patients with a current diagnosis of heart failure due to left ventricular systolic dysfunction who are currently treated with an ACE-I or ARB, the percentage of patients who are additionally currently treated with a beta-blocker licensed for heart failure.
Data collection end: March 2015
76.4%
Area covered: England
Source: Health and Social Care Information Centre. Quality Outcomes Framework.

What was measured: Proportion of patients with heart failure who were prescribed an ACE and/or ARB, beta blocker and mineralocorticoid receptor antagonists (MRA).
Data collection end: March 2015
42%
Area covered: National
Source: National Institute for Cardiovascular Outcomes Research. National Heart Failure Audit.

What was measured: The proportion of patients with left ventricular systolic dysfunction prescribed angiotensin-converting-enzymeinhibitor (ACEi) or angiotensin receptor blocker (ARB).
Data collection end: December 2014
91%
Area covered: Local
Source: Guha K, Vazir A, Guha K, et al. (2016) Audit of a tertiary heart failure outpatient service to assess compliance with NICE guidelines Clinical Medicine 16 (5) : 407-411.

What was measured: The proportion of patients with left ventricular systolic dysfunction prescribed a beta blocker.
Data collection end: December 2014
89%
Area covered: Local
Source: Guha K, Vazir A, Guha K, et al. (2016) Audit of a tertiary heart failure outpatient service to assess compliance with NICE guidelines Clinical Medicine 16 (5) : 407-411.

What was measured: HF003: In those patients with a current diagnosis of heart failure due to left ventricular systolic dysfunction, the percentage of patients who are currently treated with an ACE-I or ARB.
Data collection end: March 2016
84.7%
Data collection end: March 2017
83.9%
Area covered: National
Source: Health and Social Care Information Centre. Quality and Outcomes Framework.


Recommendation: 1.2.2.7

Offer beta-blockers licensed for heart failure to all patients with heart failure due to left ventricular systolic dysfunction, including: older adults and patients with: - peripheral vascular disease - erectile dysfunction - diabetes mellitus - interstitial pulmonary disease and - chronic obstructive pulmonary disease (COPD) without reversibility. [new 2010]

What was measured: Proportion of patients with heart failure who were prescribed a beta blocker on discharge for LVSD.
Data collection end: March 2014
85%
Data collection end: March 2015
86%
Area covered: National
Source: National Institute for Cardiovascular Outcomes Research. National Heart Failure Audit.

What was measured: HG004: In those patients with a current diagnosis of heart failure due to left ventricular systolic dysfunction who are currently treated with an ACE-I or ARB, the percentage of patients who are additionally currently treated with a beta-blocker licensed for Heart failure.
Data collection end: March 2016
77.7%
Data collection end: March 2017
78.8%
Area covered: National
Source: Health and Social Care Information Centre. Quality and Outcomes Framework.


Recommendation: 1.2.2.14

Consider an ARB licensed for heart failure as an alternative to an ACE inhibitor for patients with heart failure due to left ventricular systolic dysfunction who have intolerable side effects with ACE inhibitors

What was measured: Proportion of patients with heart failure who were prescribed an Angiotensin II receptor antagonists (ARB) on discharge for LVSD.
Data collection end: March 2014
19%
Data collection end: March 2015
19%
Area covered: National
Source: National Institute for Cardiovascular Outcomes Research. National Heart Failure Audit.

What was measured: Proportion of patients with heart failure who were prescribed an ACE and/or ARB on discharge for LVSD.
Data collection end: March 2014
85%
Data collection end: March 2015
84%
Area covered: National
Source: National Institute for Cardiovascular Outcomes Research. National Heart Failure Audit.

What was measured: In those patients with a current diagnosis of heart failure due to left ventricular systolic dysfunction, the percentage of patients who are currently treated with an ACE-I or ARB.
Data collection end: March 2016
84.7%
Data collection end: March 2017
83.9%
Area covered: National
Source: Health and Social Care Information Centre. Quality and Outcomes Framework.


Recommendation: 1.2.2.17

Diuretics should be routinely used for the relief of congestive symptoms and fluid retention in patients with heart failure, and titrated (up and down) according to need following the initiation of subsequent heart failure therapies.

What was measured: Proportion of patients with heart failure who were prescribed a loop diuretic on discharge for LVSD.
Data collection end: March 2014
91%
Data collection end: March 2015
92%
Area covered: National
Source: National Institute for Cardiovascular Outcomes Research. National Heart Failure Audit.

What was measured: Proportion of patients with heart failure who were prescribed a thiazide diuretic on discharge for LVSD.
Data collection end: March 2014
5%
Data collection end: March 2015
6%
Area covered: National
Source: National Institute for Cardiovascular Outcomes Research. National Heart Failure Audit.


Recommendation: 1.3.1.1

Offer a supervised group exercise-based rehabilitation programme designed for patients with heart failure. Ensure the patient is stable and does not have a condition or device that would preclude an exercise-based rehabilitation programme. Include a psychological and educational component in the programme. The programme may be incorporated within an existing cardiac rehabilitation programme.

What was measured: Proportion of patients with chronic heart failure that were referred to a rehabilitation programme.
Data collection end: December 2014
3%
Area covered: Local
Source: Guha K, Vazir A, Guha K, et al. (2016) Audit of a tertiary heart failure outpatient service to assess compliance with NICE guidelines Clinical Medicine 16 (5) : 407-411.


Recommendation: 1.5.3.1

Heart failure care should be delivered by a multidisciplinary team with an integrated approach across the healthcare community. [2003]

What was measured: Proportion of patients with heart failure who were seen by a member of the heart failure multidisciplinary team (MDT) on their first admission.
Data collection end: March 2014
66%
Area covered: National
Source: National Institute for Cardiovascular Outcomes Research. National Heart Failure Audit.

What was measured: Proportion of patients with heart failure who were seen by a member of the heart failure multidisciplinary team (MDT) on readmission.
Data collection end: March 2014
68%
Area covered: National
Source: National Institute for Cardiovascular Outcomes Research. National Heart Failure Audit.

What was measured: Proportion of patients with heart failure who had a follow-up appointment with MDT scheduled within two weeks of discharge.
Data collection end: March 2014
31%
Area covered: National
Source: National Institute for Cardiovascular Outcomes Research. National Heart Failure Audit.

What was measured: Proportion of patients with heart failure who had a follow-up appointment with MDT scheduled.
Data collection end: March 2014
55%
Area covered: National
Source: National Institute for Cardiovascular Outcomes Research. National Heart Failure Audit.


Recommendation: 1.5.9.3

Patients with heart failure and their carers should have access to professionals with palliative care skills within the heart failure team. [2003]

What was measured: Proportion of patients with heart failure who were given a follow-up referral to palliative care.
Data collection end: March 2014
4%
Area covered: National
Source: National Institute for Cardiovascular Outcomes Research. National Heart Failure Audit.



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