Quality statement 2: Transthoracic doppler 2D echocardiography

Quality statement

Adults admitted to hospital with new suspected acute heart failure and raised natriuretic peptide levels have a transthoracic doppler 2D echocardiogram within 48 hours of admission.

Rationale

Performing a transthoracic doppler 2D echocardiogram within 48 hours of hospital admission for adults with new suspected acute heart failure and raised natriuretic peptide levels will enable earlier diagnosis and appropriate management in terms of pharmacological treatment, location of care and relevant input from the specialist heart failure team.

Quality measures

Structure

Evidence of local arrangements to ensure that adults admitted to hospital with new suspected acute heart failure and raised natriuretic peptide levels have a transthoracic doppler 2D echocardiogram within 48 hours of admission.

Data source: Local data collection.

Process

Proportion of adults admitted to hospital with new suspected acute heart failure and raised natriuretic peptide levels who have a transthoracic doppler 2D echocardiogram within 48 hours of admission.

Numerator – the number in the denominator who have a transthoracic doppler 2D echocardiogram within 48 hours of admission.

Denominator – the number of hospital episodes of adults with new suspected acute heart failure and raised natriuretic peptide levels.

Data source: Local data collection.

Outcome

a) Mortality rates.

Data source: Local data collection. National data are collected in the National Institute for Cardiovascular Outcomes Research heart failure audit 2012–2013.

b) Length of stay.

Data source: Local data collection. National data are collected in the National Institute for Cardiovascular Outcomes Research heart failure audit 2012–2013.

c) Incidence of adverse events (withdrawal of beta‑blockers and other disease‑modifying drugs).

Data source: Local data collection. National data are collected in the National Institute for Cardiovascular Outcomes Research heart failure audit 2012–2013.

d) Readmission rates.

Data source: Local data collection. National data are collected in the National Institute for Cardiovascular Outcomes Research heart failure audit 2012–2013.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (cardiac and radiology services) ensure that adults admitted to hospital with new suspected acute heart failure and raised natriuretic peptide levels have a transthoracic doppler 2D echocardiogram within 48 hours of admission.

Healthcare professionals ensure that adults admitted to hospital with new suspected acute heart failure and raised natriuretic peptide levels have a transthoracic doppler 2D echocardiogram within 48 hours of admission.

Commissioners (clinical commissioning groups) ensure that adults admitted to hospital with new suspected acute heart failure and raised natriuretic peptide levels have a transthoracic doppler 2D echocardiogram within 48 hours of admission.

What the quality statement means for patients, service users and carers

Adults admitted to hospital with new suspected acute heart failure have their natriuretic peptide levels (also known as BNP or NT‑proBNP) in their blood measured. If the level is raised, they have an echocardiogram within 48 hours of admission to help find out if there is something wrong with their heart.

Source guidance

  • Acute heart failure (2014) NICE guideline CG187, recommendations 1.2.3 (key priority for implementation) and 1.2.4 (key priority for implementation)

Definition of terms used in this quality statement

Transthoracic doppler 2D echocardiogram

An echocardiogram is a test that uses ultrasound waves to measure the pumping action and structure of the heart, including the heart valves. A probe is moved over the surface of the chest and picks up echoes of sound (similar to an ultrasound scan used in pregnancy), which are shown as a picture on a screen.

[Adapted from Information for the public for acute heart failure: diagnosis and assessment]