Case study from Spotlight series

Providing monthly feedback with a national audit

16 June, 2020

The Danish Heart Failure Registry was implemented in 2003 to monitor and improve the quality of heart failure (HF) care across the country.

Participation in the registry is mandatory for all hospitals and outpatient cardiology clinics, and data are entered for each person diagnosed with HF for the first time. Feedback reports assessing care in all organisations across the country were initially provided every three months, and are now provided every month. These reports enable understanding of performance in each organisation and comparison with others.

The quality indicators used in the registry were selected by a multidisciplinary panel of experts, who consulted national and international guidelines as well as published literature. This panel, which now includes two patient representatives, meets annually to review the indicator framework and make changes when deemed necessary. It also reviews audit findings each year and identifies hospitals that are not meeting established standards to discuss results and identify barriers to best practice.

Since the introduction of the HF registry in Denmark, there have been substantial improvements in a range of care processes, partly attributed to the registry, including the use of echocardiography and provision of physical training and patient education. Good performance on process indicators in the registry is significantly associated with reduced mortality within one year of diagnosis.


Nakano A, Johnsen SP, Frederiksen BL, et al. 2013. Trends in quality of care among patients with incident heart failure in Denmark 2003-2010: a nationwide cohort study. BMC Health Serv Res 13: 391

Nakano A, Vinter N, Egstrup K, et al. 2019. Association between process performance measures and 1-year mortality among patients with incident heart failure: a Danish nationwide study. Eur Heart J Qual Care Clin Outcomes 5(1): 28-34

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