Quality standard

Quality statement 5: Review of people with chronic heart failure

Quality statement 5: Review of people with chronic heart failure

Quality statement

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

Rationale

Adults with 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

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.

Process

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

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

Denominator – the number of adults with chronic heart failure.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

Outcome

Hospital admissions due to heart failure.

Data source: The National Heart Failure Audit contains data on hospital admission rates for heart failure.

What the quality statement means for different audiences

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

Healthcare professionals (GPs and specialist multidisciplinary heart failure team members) ensure that they review adults with 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 (integrated care systems) ensure that they commission services in which adults with chronic heart failure have a review of their condition at least every 6 months.

Adults with chronic heart failure are seen at least every 6 months by their healthcare professional, who will check how they are managing with their condition, 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

Chronic heart failure in adults: diagnosis and management. NICE guideline NG106 (2018), recommendations 1.7.1 and 1.7.3

Definitions of terms used in this quality statement

Review of people with chronic heart failure

Reviews 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

  • an assessment of renal function.

Every 6 months, the person should have their clinical record updated by their primary care team, and any changes should be understood and agreed by the person with heart failure and shared with the specialist heart failure multidisciplinary team.

Healthcare professionals involved in the review should have a copy of the person's care plan, which should include information on:

  • diagnosis and aetiology

  • medicines prescribed, monitoring of medicines, when medicines should be reviewed and any support the person needs to take the medicines

  • functional abilities and any social care needs

  • social circumstances, including carers' needs

  • plans for managing the person's heart failure, including follow-up care, rehabilitation and access to social care

  • symptoms to look out for in case of deterioration

  • a process for any subsequent access to the specialist heart failure multidisciplinary team if needed

  • contact details for:

    • a named healthcare coordinator (usually a specialist heart failure nurse)

    • alternative local heart failure specialist care providers, for urgent care or review

  • additional sources of information for people with heart failure.

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

For people with a cardioverter defibrillator, the review should consider benefits and potential harms of it remaining active.

More detailed monitoring is needed if the person has significant comorbidity or if their condition has deteriorated since the previous review. Monitoring serum potassium is particularly important if a person is taking digoxin or a mineralocorticoid receptor antagonist.

People with heart failure who wish to be involved in the monitoring of their condition should be provided with sufficient education and support to do this, with clear guidelines as to what to do in the event of deterioration. [Adapted from the BNF treatment summary on chronic heart failure and NICE's guideline on chronic heart failure in adults, recommendations 1.1.4, 1.1.7 to 1.1.9, 1.6.5, 1.6.6, 1.7.1 to 1.7.4 and 1.8.4]