Quality statement 2: Urgent specialist assessment within 2 weeks

Quality statement

Adults with suspected chronic heart failure and either a previous myocardial infarction (MI) or very high levels of serum natriuretic peptides, who have been referred for diagnosis, have an echocardiogram and specialist assessment within 2 weeks. [2011, updated 2016]

Rationale

Adults who have had a previous MI or who have very high levels of serum natriuretic peptides have a higher likelihood of heart failure and a poorer prognosis. The time taken for diagnostic testing and assessment is particularly important for these patients. Having an echocardiogram and specialist assessment within 2 weeks of referral can help to ensure that the person is started on appropriate medication to reduce any further long‑term damage to the heart.

Quality measures

Structure

Evidence of local arrangements and written clinical protocols to ensure that adults with suspected chronic heart failure and either a previous MI or very high levels of serum natriuretic peptides, who have been referred for diagnosis, have an echocardiogram and specialist assessment within 2 weeks.

Data source: Local data collection.

Process

Proportion of adults with suspected chronic heart failure and either a previous MI or very high levels of serum natriuretic peptides, who have been referred for diagnosis, who have an echocardiogram and specialist assessment within 2 weeks of referral.

Numerator – the number in the denominator who have an echocardiogram and a specialist assessment within 2 weeks of referral.

Denominator – the number of adults referred for diagnosis with suspected chronic heart failure and either a previous MI or very high levels of serum natriuretic peptides.

Data source: Local data collection.

Outcome

a) Mortality due to heart failure.

Data source: Local data collection.

b) Hospital admissions, inpatient hospital days and readmissions due to heart failure.

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 for adults with suspected chronic heart failure referred for diagnosis to have an echocardiogram and be seen by a specialist within 2 weeks of referral if they have had a previous MI or have very high levels of serum natriuretic peptides.

Healthcare professionals (such as specialists in cardiac care) ensure that adults with suspected chronic heart failure referred for diagnosis have an echocardiogram and are seen within 2 weeks of referral if they have had a previous MI or have very high levels of serum natriuretic peptides.

Commissioners (such as clinical commissioning groups) ensure that they commission services in which adults with suspected chronic heart failure referred for diagnosis have an echocardiogram and are seen by a specialist within 2 weeks of referral if they have had a previous MI or have very high levels of serum natriuretic peptides.

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

Adults with symptoms of chronic heart failure who have been referred for diagnosis have a test called an echocardiogram and are seen by a heart specialist. This should happen within 2 weeks of being referred by their GP if they have had a heart attack in the past or if a blood test shows high levels of a substance (called a 'serum natriuretic peptide') that suggests they may have heart failure needing urgent treatment. An echocardiogram is a test to check the structure of their heart and how well it is working. The specialist 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 the condition.

Source guidance

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].

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 this 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)]

Very high levels of serum natriuretic peptides

Levels of serum natriuretic peptides (B‑type natriuretic peptide [BNP] and N‑terminal pro‑B‑type natriuretic peptide [NTproBNP]) in the blood are raised in people with heart failure. Very high levels of serum natriuretic peptides are defined as a BNP level above 400 pg/ml or an NTproBNP level above 2000 pg/ml.
[Adapted from Chronic heart failure in adults (NICE guideline CG108), recommendation 1.1.1.4]