Heart Failure Audit (HFA) Context Page

**Please note: updated information pending**

The Heart Failure Audit was established in 2007 to monitor the care and treatment of patients in England and Wales with acute heart failure. The audit reports on all patients discharged from hospital with a primary diagnosis of heart failure, publishing analysis on patient outcomes and clinical practice. Audit findings can be used to measure the implementation of contemporary guidelines for the clinical management of heart failure from the National Institute for Health and Clinical Excellence (NICE) and the European Society of Cardiology Heart Failure Association (ESC HFA). The audit is delivered by the National Institute of Cardiovascular Outcomes Research (NICOR) hosted by Barts Health NHS Trust.

To view the full audit data set visit the NICOR Heart Failure Audit website

Metrics:

Case ascertainment

• Rationale: This metric shows the proportion of eligible cases that were submitted to the audit.
• Guideline/mapping: There is no national guideline related to case ascertainment however NHS providers are required to participate in national clinical audit as part of their standard contract.
• Graph/relative performance: Compare to the national aggregate (the average). Values can be greater than 100% due to coding discrepancies.
• Quality improvement prompt question: Consider the other metrics in context of case ascertainment; particularly where ascertainment is low. If case ascertainment is low, this should be followed-up with the relevant audit lead to explore poor engagement.

Crude proportion of inpatients admitted with Heart Failure (HF) who receive input from the specialist team

• Rationale: A dedicated specialist heart failure team with early involvement is important for cost‑effective care. It can also positively contribute to rapid diagnosis, reduced readmissions and better quality of life. Ongoing input of the dedicated specialist heart failure team will also help to ensure appropriate care and make subsequent readmission less likely.
• Guideline/mapping: This metric maps to Quality standard [QS103] Quality Statement 3 “Adults admitted to hospital with acute heart failure have input within 24 hours of admission from a dedicated specialist heart failure team” with a standard of 100% in keeping with this QS.
• Graph/relative performance: Compare to the national aggregate (the average) and national standard.
• Quality improvement prompt question: When performance is lower than the national standard or national average this should prompt questions about how admissions with heart failure are identified and referred for specialist input and the capacity of the team to attend to patients.

Crude proportion of inpatients admitted with HF who receive cardiology follow up

• Rationale: It is important that adults with acute heart failure have early specialist heart failure follow‑up by a member of the community- or hospital‑based specialist heart failure team within 2 weeks of hospital discharge to reduce early readmissions, achieve better long‑term outcomes and improve their quality of life.
• Guideline/mapping: This metric maps to Quality standard [QS103] Quality Statement 6 “Adults with acute heart failure have a follow‑up clinical assessment by a member of the community- or hospital‑based specialist heart failure team within 2 weeks of hospital discharge” with a standard of 90%.
• Graph/relative performance: Compare to the national aggregate (the average).
• Quality improvement prompt question: When performance is lower than the national standard or national average this should prompt questions about how follow up is organised post discharge either through services provide by the Trust or referral to community services.

Crude proportion of patients with HF with reduced fraction who are discharged from hospital on: an ACEI/ARB

• Rationale: Early initiation of ACE inhibitors and aldosterone antagonists for adults with acute heart failure is positively associated with improved outcomes such as lower mortality and readmission rates. If the ACE inhibitor has intolerable side effects, an angiotensin receptor blocker will be offered.
• Guideline/mapping: This metric maps to Quality standard [QS103] Quality Statement 5 “Adults admitted to hospital with acute heart failure and reduced left ventricular ejection fraction are offered an angiotensin‑converting enzyme (ACE) inhibitor and an aldosterone antagonist” with a standard of 80%.
• Graph/relative performance: Compare to the national aggregate (the average).
• Quality improvement prompt question: When performance is lower than the national standard or national average this should prompt questions about the process of reviewing medications prior to or at discharge to identify patients that should be prescribed a ACEI/ARB .

Crude proportion of patients with HF with reduced fraction who are discharged from hospital on: Beta-blocker

• Rationale: In-hospital introduction of beta‑blockers is associated with increased use of beta‑blockers at follow‑up and better long‑term outcomes such as fewer adverse events and reduced mortality. Also, it is important that beta‑blocker treatment is continued for adults who are already taking it.
• Guideline/mapping: This metric maps to Quality standard [QS103] Quality Statement 4 “Adults with acute heart failure due to left ventricular systolic dysfunction are started on, or continue with, beta‑blocker treatment during their hospital admission” with a standard of 80%.
• Graph/relative performance: Compare to the national aggregate (the average).
• Quality improvement prompt question: When performance is lower than the national standard or national average this should prompt questions about the process of reviewing medications prior to or at discharge to identify patients that should be prescribed a beta blocker.

Crude proportion of patients with HF with reduced fraction who are discharged from hospital on: Mineralocorticoid receptor antagonist (MRA)

• Rationale: Early initiation of ACE inhibitors and aldosterone antagonists (also known as Mineralocorticoid reception antagonist) for adults with acute heart failure is positively associated with improved outcomes such as lower mortality and readmission rates. If the ACE inhibitor has intolerable side effects, an angiotensin receptor blocker will be offered.
• Guideline/mapping: This metric maps to Quality standard [QS103] Quality Statement 5 “Adults admitted to hospital with acute heart failure and reduced left ventricular ejection fraction are offered an angiotensin‑converting enzyme (ACE) inhibitor and an aldosterone antagonist” with a standard of 80%.
• Graph/relative performance: Compare to the national aggregate (the average).
• Quality improvement prompt question: When performance is lower than the national standard or national average this should prompt questions about the process of reviewing medications prior to or at discharge to identify patients that should be prescribed a Mineralocorticoid receptor antagonist (MRA).