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: diagnosis and management (2018) NICE guideline NG106, recommendations 1.2.2, 1.2.4 and 1.2.6

Definitions of terms used in this quality statement

Specialist

The core specialist heart failure multidisciplinary team includes:

  • a lead physician with subspecialty training in heart failure (usually a consultant cardiologist) who is responsible for making the clinical diagnosis

  • a specialist heart failure nurse

  • a healthcare professional with expertise in specialist prescribing for heart failure.

[Adapted from NICE's guideline on chronic heart failure in adults, recommendation 1.1.1]