Quality statement 5: Drug therapy

Quality statement

Adults admitted to hospital with acute heart failure and reduced left ventricular ejection fraction are offered an angiotensin‑converting enzyme (ACE) inhibitor and an aldosterone antagonist.

Rationale

Early initiation of ACE inhibitors and aldosterone antagonists for adults with acute heart failure is positively associated with improved outcomes such as lower mortality and readmission rates. If the ACE inhibitor has intolerable side effects, an angiotensin receptor blocker will be offered.

Quality measures

Structure

Evidence of local arrangements to ensure that adults admitted to hospital with acute heart failure and reduced left ventricular ejection fraction are offered an ACE inhibitor and an aldosterone antagonist.

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

Process

Proportion of new hospital admissions for adults with acute heart failure and reduced left ventricular ejection fraction when an ACE inhibitor and an aldosterone antagonist are offered.

Numerator – the number in the denominator treated with an ACE inhibitor and an aldosterone antagonist.

Denominator – the number of new hospital admissions for adults with acute heart failure and reduced left ventricular ejection fraction.

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) 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 service providers) ensure that adults admitted to hospital with acute heart failure and reduced left ventricular ejection fraction are offered an ACE inhibitor and an aldosterone antagonist.

Healthcare professionals ensure that adults admitted to hospital with acute heart failure and reduced left ventricular ejection fraction are offered an ACE inhibitor and an aldosterone antagonist.

Commissioners (clinical commissioning groups) ensure that adults admitted to hospital with acute heart failure and reduced left ventricular ejection fraction are offered an ACE inhibitor and an aldosterone antagonist.

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

Adults admitted to hospital with acute heart failure and reduced left ventricular ejection fraction are offered an angiotensin‑converting enzyme inhibitor (also known as an ACE inhibitor) and an aldosterone antagonist.

Source guidance

  • Acute heart failure (2014) NICE guideline CG187, recommendation 1.5.4 (key priority for implementation)

Definition of terms used in this quality statement

Reduced left ventricular ejection fraction

The fraction of blood that is pumped out from the left ventricle during each heartbeat. In healthy people it is typically at least 55%. It is reduced in systolic heart failure.

[Expert consensus]