Quality standard


This quality standard covers the care of adults (aged 18 years or older) who have a diagnosis of acute heart failure or are being investigated for acute heart failure. The long‑term management of chronic heart failure is not covered in the quality standard because it is covered by a separate NICE guideline (CG108) and quality standard referral (QS9). For more information see the topic overview.

Why this quality standard is needed

Acute heart failure refers to the rapid onset of a clinical syndrome where the heart is unable to pump sufficient blood to provide for the needs of the body. It is caused by dysfunction of the heart due to muscle damage (systolic or diastolic dysfunction), valvular dysfunction, arrhythmias or other rare causes. Acute heart failure can present as new‑onset heart failure in people without known cardiac dysfunction, or as acute decompensation of chronic heart failure.

Acute heart failure is a common cause of admission to hospital (over 67,000 admissions in England and Wales a year) and is the leading cause of hospital admission in people 65 years or older in the UK.

The quality standard is expected to contribute to improvements in the following outcomes:

  • mortality rates

  • incidence of major cardiovascular events (non‑fatal myocardial infarction, stroke)

  • length of hospital stay

  • readmission rates

  • incidence of adverse events (withdrawal of beta‑blockers and other disease‑modifying drugs)

  • quality of life.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable improvements in the 3 dimensions of quality – patient safety, patient experience and clinical effectiveness – for a particular area of health or care. They are derived from high‑quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2015–16


Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicators

1a Potential Years of Life Lost (PYLL) from causes considered amenable to healthcare

i Adults

1b Life expectancy at 75

i Males ii Females

1.1 Under 75 mortality rate from cardiovascular disease* (PHOF 4.4*)

3 Helping people to recover from episodes of ill‑health or following injury

Overarching indicator

3b Emergency readmissions within 30 days of discharge from hospital* (PHOF 4.11*)

4 Ensuring that people have a positive experience of care

Overarching indicators

4b Patient experience of hospital care

4c Friends and family test

4d Patient experience characterised as poor or worse

i. Primary care

ii. Hospital care

Improvement areas

Improving people's experience of outpatient care

4.1 Patient experience of outpatient services

Improving hospitals' responsiveness to personal needs

4.2 Responsiveness to in‑patients' personal needs

Improving people's experience of accident and emergency services

4.3 Patient experience of A&E services

5 Treating and caring for people in a safe environment and protecting them from avoidable harm

Overarching indicators

5a Deaths attributable to problems in healthcare

5b Severe harm attributable to problems in healthcare

Improvement area

Improving the culture of safety reporting

5.6 Patient safety incidents reported

Alignment with Public Health Outcomes Framework

* Indicator shared

** Indicator complementary

Indicators in italics are in development

Table 2 Public health outcomes framework for England, 2013–16


Objectives and indicators

4 Healthcare public health and preventing premature mortality


Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities


4.4 Under 75 mortality rate from cardiovascular disease* (NHSOF 1.1*)

4.11 Emergency readmissions within 30 days of discharge* from hospital (NHSOF 3b*)

4.13 Health‑related quality of life for older people

Alignment with NHS Outcomes Framework

* Indicator shared

Patient experience and safety issues

Ensuring that care is safe and that people have a positive experience of care is vital in a high‑quality service. It is important to consider these factors when planning and delivering services relevant to acute heart failure.

NICE has developed guidance and an associated quality standard on patient experience in adult NHS services (see the NICE pathway on patient experience in adult NHS services), which should be considered alongside this quality standard. They specify that people receiving care should be treated with dignity, have opportunities to discuss their preferences, and are supported to understand their options and make fully informed decisions. They also cover the provision of information to patients and service users. Quality statements on these aspects of patient experience are not usually included in topic‑specific quality standards. However, recommendations in the development sources for quality standards that impact on patient experience and are specific to the topic are considered during quality statement development.

Coordinated services

The quality standard for acute heart failure specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole acute heart failure care pathway. A person‑centred, integrated approach to providing services is fundamental to delivering high‑quality care to adults with acute heart failure.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high‑quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high‑quality acute heart failure service are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing, caring for and treating adults with acute heart failure should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development source on specific types of training for the topic that exceed standard professional training are considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting adults with acute heart failure. If appropriate, healthcare professionals should ensure that family members and carers are involved in the decision‑making process about investigations, treatment and care.