NICOR: National Institute for Cardiovascular Outcomes Research

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Data

The British Society of Heart Failure has chosen to initially focus on auditing care within secondary care with a view to extending into primary care in the future.

The need to extend the scope to primary settings has also been highlighted in the Healthcare Commission Report "Pushing the Boundaries: Improving services for people with heart failure (2007)" .

The aims of audit

The audit assesses both clinical care and patient related outcomes and:

• Identifies the percentage of people admitted to hospital with heart failure who have quality of care recorded
• Describes current clinical practice in heart failure diagnosis, care and treatment and to explain variation in practice using data on patient characteristics and access to services.
• Describes the following patient outcomes: length of stay, in-hospital mortality and late mortality (up to one year post discharge).

Identifying patients

The audit measures the quality of care for all inpatients in secondary care discharged with a primary diagnosis of heart failure using the following codes:

I50.0 Congestive heart failure

I50.1 Left ventricular failure

I50.9 Heart failure, unspecified

I11.0 Hypertensive heart disease with (congestive) heart failure

I42.0 Dilated cardiomyopathy

I25.5 Ischaemic cardiomyopathy

I42.9 Cardiomyopathy, unspecified.

The most effective way of ensuring all patients treated for heart failure are included in the audit is to use discharge codes and input data from patient notes. A proforma for collecting data is available via the Dataset Page.

Some hospitals will initially identify patients who are referred to cardiology or HF specialist services. In addition, the coding department highlight all cases on a monthly basis. Missed cases have helped clinical teams identify patients who were not referred to the service. This information has helped to improve the referral process.

Data can aso be imported from existing IT systems (either in-house or via third party IT suppliers) to provide direct data links to the heart failure database.

Number of cases

Initially, the focus of the audit was to ensure that all Trusts were registered and submitting data. The audit now aims to capture all cases of heart failure, so hospitals should include all unscheduled admissions to hospital with a primary discharge diagnosis of heart failure. The audit will compare the number of  cases submitted to the audit with expected cases (based on HES discharge data) to monitor case ascertainment.

Data quality

There are a number of data entry validation checks in the audit application to ensure that contradictory and  impossible data cannot be submitted (e.g. invalid dates, clinical contradictions). The audit will contact hospitals with poor data quality, for example, where 'unknown' is overused, or where core non-mandatory fields are missing. Before any outcome data is published data hospital level, preliminary analyses will be sent to all clinical leads to ensure that the data submitted to the audit is correct. However hospitals are ultimately responsible for the quality of the data that they include in the audit.