Quality standard
Quality statement 5: Drug therapy
Quality statement 5: Drug therapy
Quality statement
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.
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.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that adults admitted to hospital with acute heart failure and reduced left ventricular ejection fraction are offered an ACE inhibitor and an aldosterone antagonist.
Data source: Local data collection. National data are collected in the National Institute for Cardiovascular Outcomes Research heart failure audit 2012/13.
Process
Proportion of new hospital admissions for adults with acute heart failure and reduced left ventricular ejection fraction when an ACE inhibitor and an aldosterone antagonist are offered.
Numerator – the number in the denominator treated with an ACE inhibitor and an aldosterone antagonist.
Denominator – the number of new hospital admissions for adults with acute heart failure and reduced left ventricular ejection fraction.
Data source: Local data collection.
Outcome
a) Mortality rates.
Data source: Local data collection. National data are collected in the National Institute for Cardiovascular Outcomes Research heart failure audit 2012/13.
b) Readmission rates.
Data source: Local data collection. National data are collected in the National Institute for Cardiovascular Outcomes Research heart failure audit 2012/13.
What the quality statement means for different audiences
Service providers (cardiac service providers) ensure that adults admitted to hospital with acute heart failure and reduced left ventricular ejection fraction are offered an ACE inhibitor and an aldosterone antagonist.
Healthcare professionals ensure that adults admitted to hospital with acute heart failure and reduced left ventricular ejection fraction are offered an ACE inhibitor and an aldosterone antagonist.
Commissioners ensure that adults admitted to hospital with acute heart failure and reduced left ventricular ejection fraction are offered an ACE inhibitor and an aldosterone antagonist.
Adults admitted to hospital with acute heart failure and reduced left ventricular ejection fraction are offered an angiotensin‑converting enzyme inhibitor (also known as an ACE inhibitor) and an aldosterone antagonist.
Source guidance
Acute heart failure: diagnosis and management. NICE guideline CG187, recommendation 1.5.4 (key priority for implementation)