The National Heart Failure Audit collects data on patients with an unscheduled admission to hospital in England and Wales who are discharged with a primary diagnosis of heart failure.
The audit aims to drive up the quality of the diagnosis, treatment and management of heart failure by collecting, analysing and disseminating data, and eventually to improve mortality and morbidity outcomes for heart failure patients. The audit is managed by NICOR, with clinical direction and strategy provided by the British Society of Heart Failure (BSH). The audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP).
The National Heart Failure Audit was established in 2007. The audit aims to capture data on clinical indicators which have a proven link to improved outcomes for heart failure patients, and to encourage the increased use of clinically recommended diagnostic tools, disease modifying treatments and referral pathways. The dataset is updated periodically to ensure that the data collected remains in line with contemporary clinical guidance, and clinical input has been integral to the decision-making and running of the audit since its inception.
Heart failure is a complex clinical syndrome where the heart does not adequately pump blood around the body. As the heart is not able to supply enough oxygen to the body, heart failure often leads to shortness of breath and fatigue, and can also lead to fluid retention in the chest cavity, legs and ankles. It is a long term condition, which sufferers can live with for many years, and can be treated by pharmacological treatments – such as beta blockers and ACE inhibitors – or by device therapies – for example, pacemakers or defibrillators. Heart failure is caused by a variety of cardiac abnormalities, such as previous heart attacks, cardiomyopathies, hypertension and valve disease.
Heart failure affects around 900,000 people in the UK, and this number is likely to rise, due to an ageing population, more effective treatments, and improved survival rates after a heart attack. Heart failure is a large burden on the NHS, accounting for 1 million bed days per year, 2% of the NHS total, and 5% of all emergency admissions to hospital.
The role of the audit is to collect data on the treatment and management of heart failure patients, and to disseminate information to hospitals, government bodies and research groups to help highlight clinical practice and outcomes which do not meet optimal standards and to drive service improvement. Participation in the audit has been compulsory for English NHS Trusts since April 2011 by the Department of Health’s NHS Standard Contracts for Acute Hospital Services; participation in the audit has been mandatory in Wales since April 2012.
Mortality rates for heart failure patients are high, with 40% of newly diagnosed patients dying within a year, and 50% of patients either readmitted to hospital or dying within a year of admission to hospital. However despite these poor outcomes, early diagnosis, optimal treatment and responsive management can result in significantly increased life expectancy, as well as better quality of life for heart failure patients.
The audit therefore reports on the variation in practice across England and Wales, and recommends compliance with evidence-based clinical guidelines in order to improve the quality of care and outcomes for patients with heart failure.
Clinical guidance and strategic direction is given by the British Society of Heart Failure (BSH). The audit is funded and commissioned by the Healthcare Quality Improvement Partnership (HQIP) and, along with the five other NICOR audits, is one of 40 audits in their National Clinical Audit and Patient Outcomes Programme (NCAPOP).
The audit collects data on all patients with an unscheduled admission to hospital who are discharged with a primary discharge diagnosis of heart failure, specified by the following ICD-10 codes:
• I11.0 Hypertensive heart disease with (congestive) heart failure
• I25.5 Ischaemic cardiomyopathy
• I42.0 Dilated cardiomyopathy
• I42.9 Cardiomyopathy, unspecified
• I50.0 Congestive heart failure
• I50.1 Left ventricular failure
• I50.9 Heart failure, unspecified
The audit dataset covers a patient’s entire hospital admission, including medical history, diagnosis, physical examinations and tests taken, in-hospital care and monitoring, treatment on discharge and onwards referral.
Datasets, pro formas and user guides for the audit can be found in the Datasets section.
The audit uses the following clinical guidelines as benchmarks for data collection and analysis:
Audit data is used in a number of ways to drive improvement in heart failure services and patient outcomes. Primarily, data is fed back to individual hospitals to report on their clinical practice and outcomes over time.
The audit provides participation rates, and hospital level data to organisations such as the Care Quality Commission’s Quality and Risk Profiles, the NHS Choices website and data.gov.uk. It is part of the National Cardiac Audit Programme (NCAP) along with five other cardiac specialties.
There are future plans to provide anonymised National Heart Failure Audit data, by hospital, to Cardiac Networks and Clinical Commissioning Groups.
Audit data is also used for research purposes, to investigate further the causes, treatment and management of heart failure. More information about the research use of National Heart Failure Audit and NICOR data can be found on the Research section of this website.