Table 3

Core data set for the management of patients with heart failure

*This is stated in the aims of the NSF but not required in either the NSF or American Heart Association data sets for audit.
ACE, angiotensin converting enzyme inhibitor; LV, left ventricle; LVSD, left ventricular systolic dysfunction; NSF, National Service Framework; NYHA, New York Heart Association (classification of heart failure).
A. Structural measures
  1. The facility should have a document that describes or endorses the best practice for its patients and that aligns with existing medical evidence

  2. Clinicians should have a mechanism to systematically monitor patient care and outcomes

  3. There must be local skilled clinicians and an organisational structure that moves patients to appropriate levels of care

  4. There should be specific programmes that address patient and carer educational needs and end of life care

B. Process: acute care
1. A current 12 lead ECG should be recorded and available in the notes of all patients
2. LV function should be documented in the records of all patients with heart failure
3. Where LVSD is confirmed, aetiology should be established*
4. Patients with oedema should be prescribed diuretic titrated to control symptoms
5. Patients with LVSD (and no contraindications) should be prescribed ACE inhibitors
6. Patients with NYHA class II or III heart failure and LVSD (and no contraindications) should be prescribed β blockers
7. Aggravating concomitant medication should be avoided
8. A discharge summary should be sent to the general practitioner within five days of discharge
B. Process: follow up
9. The patient should be seen in a specialist clinic setting and medication optimised to protocol
10. Advice and treatment regarding blood pressure control
11. Meticulous control of blood glucose in diabetic patients
12. Advice and treatment regarding fluid and salt intake
13. Advice and treatment regarding diet
14. Advice and treatment regarding smoking
15. Advice and treatment regarding alcohol
16. Advice and treatment regarding exercise
17. Influenza immunisation should be advised/offered
C. Outcome measures
The American Heart Association guidelines recommend that the following data should be gathered only as part of internal quality improvement activity. Caution should be exercised if the data are to be used as part of external comparative activity, since the evidence base lacks sufficient validity
18. Crude mortality
19. Length of stay
20. Readmission
21. Satisfaction with care