Quality statement 1: Diagnosis by a specialist

Quality statement

Adults with suspected chronic heart failure who have been referred for diagnosis have an echocardiogram and specialist assessment. [2011, updated 2016]

Rationale

To ensure that the correct diagnosis is made, adults with suspected chronic heart failure who have been referred for diagnosis should have an echocardiogram and be seen by a specialist. The specialist should assess the person and review the echocardiogram results. The echocardiogram will show any valve disease and assess the function of the left ventricle. Specialist assessment is needed to confirm the diagnosis of heart failure, consider the possible causes, discuss the appropriate treatment and develop a management plan.

Quality measures

Structure

Evidence of local arrangements to ensure that adults with suspected chronic heart failure referred for diagnosis have an echocardiogram and specialist assessment.

Data source: Local data collection.

Process

Proportion of adults with suspected chronic heart failure referred for diagnosis who have an echocardiogram and specialist assessment.

Numerator – the number in the denominator who have an echocardiogram and specialist assessment.

Denominator – the number of adults with suspected chronic heart failure who are referred for diagnosis.

Data source: Local data collection.

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

Service providers (such as hospitals) ensure that systems are in place so that adults with suspected chronic heart failure who have been referred for diagnosis have an echocardiogram and specialist assessment.

Healthcare professionals (such as doctors and specialists in cardiac care) ensure that adults with suspected chronic heart failure who have been referred for diagnosis have an echocardiogram and specialist assessment. Specialists in cardiac care should assess the person after they have had an echocardiogram.

Commissioners (such as clinical commissioning groups and NHS England) ensure that they commission services in which adults with suspected chronic heart failure who have been referred for diagnosis have an echocardiogram and specialist assessment.

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

Adults with symptoms of heart failure who have been referred for diagnosis have a test called an echocardiogram to check the structure of their heart and how well it is working. They are then seen by a heart specialist who will carry out an assessment and confirm whether they have chronic heart failure. If chronic heart failure is diagnosed, the specialist will try to find the cause, offer treatment and talk to the person about how to manage their condition.

Source guidance

  • Chronic heart failure in adults (2010) NICE guideline CG108, recommendations 1.1.1.2 (key priority for implementation), 1.1.1.4 (key priority for implementation), and 1.1.1.5

Definitions of terms used in this quality statement

Echocardiogram

An echocardiogram is a test that uses sound waves to look at the pumping action and structure of the heart, including the heart valves. A probe is moved over the chest and picks up echoes of sound, which are shown as a picture on a screen. In this statement, an echocardiogram refers to a transthoracic Doppler 2D echocardiogram.
[Adapted from Chronic heart failure in adults (NICE guideline CG108) Information for the public].

Suspected chronic heart failure

The most common symptom of chronic heart failure is shortness of breath, either with exercise or at rest. Weight gain and ankle swelling may occur. Fatigue and increased need to pass urine at night are common. A person who has heart failure may wake suddenly from a sound sleep, gasping for breath. Other signs of chronic heart failure can include a cough that won't go away, nausea, lack of appetite and confusion.
[Adapted from Chronic heart failure in adults (NICE guideline CG108) Information for the public]

Specialist

A doctor with subspecialty interest in heart failure (often a consultant cardiologist) who leads a specialist multidisciplinary heart failure team of professionals with appropriate competencies from primary and secondary care (such as GPs and heart failure specialist nurses). The team may involve other services (such as rehabilitation, tertiary care and palliative care) in the care of individual patients.

Specialist assessment or management refers to assessment or management by the specialist multidisciplinary heart failure team. The team will decide on who is the most appropriate team member to address a particular clinical problem.
[Chronic heart failure in adults (NICE guideline CG108)]