Quality standard
Quality statement 1: Assessment of left ventricular function
Quality statement 1: Assessment of left ventricular function
Quality statement
Adults admitted to hospital with a myocardial infarction (MI) have an assessment of left ventricular function before discharge.
Rationale
After an MI, some people have heart failure because of damage to heart muscle and impaired contraction of the left ventricle. This is known as left ventricular systolic dysfunction (LVSD). The effectiveness of drug treatment with angiotensin‑converting enzyme (ACE) inhibitors, angiotensin receptor blockers, aldosterone antagonists and beta‑blockers depends on left ventricular function. The assessment of left ventricular function after an MI informs the type, titration and duration of drug treatment and the type of cardiac rehabilitation that is appropriate. To improve the clinical effectiveness of treatment and to ensure patient safety, this assessment should be done before discharge from hospital.
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 an MI have an assessment of left ventricular function before discharge.
Data source: Local data collection.
Process
Proportion of discharges from hospital after an MI where the patient had an assessment of left ventricular function while in hospital.
Numerator – the number in the denominator where the patient had an assessment of left ventricular function while in hospital.
Denominator – the number of discharges from hospital after an MI.
Data source: Local data collection.
What the quality statement means for different audiences
Service providers (secondary and tertiary care services) ensure that adults admitted to hospital with an MI have an assessment of left ventricular function before discharge.
Healthcare professionals assess the left ventricular function of adults admitted to hospital with an MI before discharge.
Commissioners commission services that have the capacity and expertise to assess left ventricular function before discharge in adults admitted to hospital with an MI.
Adults who are admitted to hospital with a heart attack have a scan to see how well the blood is being pumped through their heart. This helps with decisions about the type and dose of drug treatment and the recovery programme that is appropriate for them. The scan should be done before a person leaves hospital.
Source guidance
Acute coronary syndromes. NICE guideline NG185 (2020), recommendations 1.1.27 and 1.2.26
Definitions of terms used in this quality statement
Assessment of left ventricular function
Left ventricular function can be assessed using a variety of methods, including echocardiography, cardiac magnetic resonance imaging (MRI), angiography and nuclear imaging. [Expert opinion]