Examples of what has been done

A national audit to measure implementation of clinical guidelines


The National Heart Failure Audit is a government audit that has been used to measure the implementation of NICE (National Institute for Clinical Excellence) and ESC HF guidelines in England and Wales. Findings have been used by several national UK bodies to scrutinise implementation, outcomes and effectiveness of guidelines. The audit includes several indicators to measure and improve the quality of HF care in clinical practice.

What they did

The National Heart Failure Audit was established in 2007 and monitors unplanned hospital admissions of HF patients. It collects information on the characteristics, treatment and health outcomes of HF patients, which are used to inform policy and improve the implementation of national and international HF guidelines.

To improve the quality of care in clinical HF practice quality indicators include:

  • specialist input received by HF patients (%)
  • patients diagnosed with an echocardiogram (%)
  • patients receiving discharge planning (%)
  • patients referred to follow-up services (%)
  • patients with a follow –up appointment in a multidisciplinary HF team (%)

What they achieved?

Participation in the audit is high, some 97% of NHS Trusts in England and Health Boards in Wales submitted data to the audit in 2012/2013. It recorded a total of 43,894 cases – or 60% of all coded hospitalized HF cases. 1

An analysis of the data suggests the implementation of the Audit has been linked to the improvement in the treatment and management of HF, and to the better adherence to national and international guidelines. It found a reduction in in-hospital and one-year mortality in hospitalized HF patients compared to the previous year.1

Resources and other practical implications

An analysis of Audit data identifies several practical implications and recommendations to improve the care of HF patients.

  • All hospitalized patients should see a member of a multidisciplinary HF team within 2 weeks of discharge
  • Coding of HF patients remains problematic and should be monitored more closely by hospitals
  • There is a clear minimum dataset of indicators which must be observed to ensure the return of high quality data
  • All patients should be treated according to evidence-based guidelines
  • All patients should receive care with specialist cardiology input

Links, references, and key reading




1 British Society for Heart Failure. National Heart Failure Audit April 2012-March 2013. University College London.: National Institute for Cardiovascular Outcomes Research., 2013.