National Heart Failure Audit, England and Wales

The National Heart Failure Audit is a government audit that has been used to measure the implementation of National Institute for Health and Care Excellence (NICE) and European Society of Cardiology heart failure (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.

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

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 has it achieved?

Participation in the audit is high: 97% of NHS Trusts in England and Health Boards in Wales submitted data to the audit in 2012–13. It recorded a total of 43,894 cases – 60% of all coded hospitalised HF cases.

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

Resources and other practical implications

An analysis of Audit data identifies several practical implications and recommendations to improve the care of people with HF:

• All hospitalised patients should see a member of a multidisciplinary HF team within two weeks of discharge.
• Coding of HF patients remains problematic and should be monitored more closely by hospitals.
• There is a clear minimum data set 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

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

National Heart Failure Audit website

Audit report 2013–14 by Healthcare Quality Improvement Partnership