Heart failure: 4 pillars (HFrEF)
This indicator covers the the percentage of patients with a current diagnosis of heart failure with reduced ejection fraction, who are currently treated with an angiotensin-converting enzyme inhibitor or angiotensin receptor-neprilysin inhibitor or angiotensin II receptor blocker, a beta blocker, a mineralocorticoid receptor antagonist and a sodium glucose co-transporter-2 inhibitor. It measures outcomes that reflect the quality of care or processes linked by evidence to improved outcomes.
Last reviewed: 11 November 2025
This indicator updates and replaces NICE indicators 193 and 194.
Next review: 30 November 2028
This indicator will be reviewed using the assessment criteria in appendix B of the NICE indicators process guide when it reaches its review date or the underlying guidance is updated.
How to use NICE indicators and how we develop them
Indicators can be used in a number of different settings to support high quality care. These include:
- identifying where improvements are needed
- setting priorities for quality improvement and support
- creating local performance dashboards
- benchmarking performance against national data
- supporting local quality improvement schemes
- showing progress that local health systems are making on outcomes.
Find out how to use indicators and how we develop them.