Quality statement 2: Urgent specialist assessment within 2 weeks

Quality statement

Adults with suspected chronic heart failure and 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 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 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 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 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 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 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 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 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

Chronic heart failure in adults: diagnosis and management (2018) NICE guideline NG106, recommendation 1.2.3

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]

Very high levels of serum natriuretic peptides

Levels of serum natriuretic peptides (N‑terminal pro‑B‑type natriuretic peptide [NT-proBNP]) in the blood are raised in people with heart failure. Very high levels of serum natriuretic peptides are defined as a NT-proBNP level above 2,000 ng/litre (236 pmol/litre).

[Adapted from NICE's guideline on chronic heart failure in adults, recommendation 1.2.3]