Heart Failure: ACEi or ARBs
Indicator
The percentage of patients with a current diagnosis of heart failure due to left ventricular systolic dysfunction, who are currently treated with an ACE-I or ARB.
Indicator type
General practice indicator suitable for use in the Quality and Outcomes Framework.
This document does not represent formal NICE guidance. For a full list of NICE indicators, see our menu of indicators.
To find out how to use indicators and how we develop them, see our NICE indicator process guide.
Rationale
Heart failure is a complex clinical syndrome of symptoms and signs that suggest the efficiency of the heart as a pump is impaired. It is caused by structural or functional abnormalities of the heart. QOF data for 2017/18 shows around 486,000 people in England are currently on a general practice heart failure register. Improvements in care have increased survival for people with ischaemic heart disease, and treatments for heart failure have become more effective. But the overall prevalence of heart failure is rising because of population ageing and increasing rates of obesity.
The aim of treatment with an ACE inhibitor or ARB is to reduce symptoms, reduce hospitalisations and improve survival in people with heart failure due to left ventricular systolic dysfunction.
In light of the stronger evidence base and lower cost of ACE inhibitors, the NICE guideline for chronic heart failure recommends ACE inhibitors as treatment for all people with heart failure with reduced ejection fraction (HFREF), or treatment with ARB only for people who have intolerable side effects with ACE inhibitors.
The indicator refers to left ventricular systolic dysfunction (LVSD) rather than HFREF because it is the term historically used in GP practice. However, it is recommended for the ejection fraction to be recorded and for the ACE inhibitor or ARB to be prescribed to patients with HFREF below 40% in line with the guideline.
Source guidance
Chronic heart failure in adults. NICE guideline NG106 (2018), recommendations 1.4.1 and 1.4.7
Specification
Numerator: The number of patients in the denominator who are currently treated with an ACE-I or ARB.
Denominator: The number of patients with a current diagnosis of heart failure due to left ventricular systolic dysfunction or heart failure with reduced ejection fraction.
Calculation: Numerator divided by the denominator, multiplied by 100.
Exclusions: None.
Minimum population: The indicator would be appropriate to assess performance at individual general practice level.
ISBN: 978-1-4731-5967-9