Quality standard
Quality statement 4: Starting or continuing beta‑blocker treatment
Quality statement 4: Starting or continuing beta‑blocker treatment
Quality statement
Adults with acute heart failure due to left ventricular systolic dysfunction are started on, or continue with, beta‑blocker treatment during their hospital admission.
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.
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 with acute heart failure due to left ventricular systolic dysfunction are started on, or continue with, beta‑blocker treatment during their hospital admission.
Data source: Local data collection. National data are collected in the National Institute for Cardiovascular Outcomes Research heart failure audit 2012/13.
Process
a) Proportion of adults with acute heart failure due to left ventricular systolic dysfunction who are started on beta‑blocker treatment during their hospital admission.
Numerator – the number in the denominator who are started on beta‑blocker treatment during their hospital admission.
Denominator – the number of hospital admissions of adults with acute heart failure due to left ventricular systolic dysfunction in which the patient is not already taking a beta‑blocker.
Data source: Local data collection.
b) Proportion of adults with acute heart failure due to left ventricular systolic dysfunction who continue with beta‑blocker treatment during their hospital admission.
Numerator – the number in the denominator who continue beta‑blocker treatment during their hospital admission.
Denominator – the number of hospital admissions of adults with acute heart failure due to left ventricular systolic dysfunction.
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.
c) Incidence of adverse events (withdrawal of beta‑blockers and other disease‑modifying drugs).
Data source: Local data collection. National data are collected in the National Institute for Cardiovascular Outcomes Research heart failure audit 2012/13.
d) Beta‑blocker use at follow‑up.
Data source: Local data collection.
e) 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 with acute heart failure due to left ventricular systolic dysfunction are started on, or continue with, beta‑blocker treatment during their hospital admission.
Healthcare professionals ensure that adults with acute heart failure due to left ventricular systolic dysfunction are started on, or continue with, beta‑blocker treatment during their hospital admission.
Commissioners ensure that adults with acute heart failure due to left ventricular systolic dysfunction are started on, or continue with, beta‑blocker treatment during their hospital admission.
Adults with acute heart failure due to left ventricular systolic dysfunction (known as LVSD, where the pumping chamber of the heart is not pumping well) start or continue beta‑blockers while they are in hospital.
Source guidance
Acute heart failure: diagnosis and management. NICE guideline CG187, recommendation 1.5.2 (key priority for implementation)
Definitions of terms used in this quality statement
Beta-blocker
Treatment for heart failure, heart rhythm disturbances, angina and heart attacks, and high blood pressure. [Adapted from NICE's full guideline on acute heart failure]