Quality statement 5: Review of people with stable chronic heart failure

Quality statement

Adults with stable chronic heart failure have a review of their condition at least every 6 months. [2011, updated 2016]

Rationale

Adults with stable chronic heart failure should have a review of their condition at least every 6 months to ensure that their medications are working effectively and they are not experiencing any significant side effects. This will allow their healthcare professional to assess whether there has been any deterioration in their condition, if their medications should be changed, if other procedures (such as cardiac resynchronisation therapy) should be considered and whether referral to another member of the multidisciplinary team is needed.

Quality measures

Structure

Evidence of local arrangements to ensure that adults with stable chronic heart failure have a review of their condition at least every 6 months.

Data source: Local data collection.

Process

Proportion of adults with stable chronic heart failure who have had a review of their condition during the past 6 months.

Numerator – the number in the denominator who have had a review of their condition during the past 6 months.

Denominator – the number of adults with stable chronic heart failure.

Data source: Local data collection.

Outcome

a) Quality of life.

Data source: Local data collection.

b) Renal impairment.

Data source: Local data collection.

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

Service providers (such as GP practices, hospitals and community providers) ensure that systems are in place so that adults with stable chronic heart failure have a review of their condition at least every 6 months.

Healthcare professionals (such as GPs and specialist multidisciplinary heart failure team members) ensure that they review adults with stable chronic heart failure at least every 6 months. The multidisciplinary heart failure team will decide on the most appropriate member to do this, for example, the GP may lead care in consultation with other members of the team.

Commissioners (such as clinical commissioning groups and NHS England) ensure that they commission services in which adults with stable chronic heart failure have a review of their condition at least every 6 months.

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

Adults with chronic heart failure that isn't worsening are seen at least every 6 months by their healthcare professional, who will check whether their condition has got better or worse, whether their medication needs to be changed and if other types of treatment might be suitable for them. The person may also be referred to other members of the care team, such as a heart failure specialist nurse.

Source guidance

Definitions of terms used in this quality statement

Review of people with stable chronic heart failure

This should include as a minimum:

  • clinical assessment of functional capacity, fluid status, cardiac rhythm (minimum of examining the pulse), cognitive status and nutritional status

  • review of medication, including need for changes and possible side effects

  • serum urea, electrolytes, creatinine and eGFR (estimated gromerular filtration rate).

For people taking amiodarone the review should include liver and thyroid function tests, and a review of side effects.

The review should also include a discussion about the suitability of a programme of cardiac rehabilitation.

More detailed monitoring is needed if the person has significant comorbidity or if their condition has deteriorated since the previous review.
[Adapted from Chronic heart failure in adults (NICE guideline CG108), recommendations 1.4.1.1, 1.4.1.2 and 1.2.2.22]

Adults with stable chronic heart failure

Adults diagnosed with chronic heart failure whose clinical condition has not deteriorated, whose heart medication has not been changed and who have not been admitted to hospital because of heart failure.
[Adapted from Chronic heart failure in adults (NICE guideline CG108)]