NICOR: National Institute for Cardiovascular Outcomes Research

This dataset contains information on the clinical treatment of acute heart failure patients in hospitals in England between 1 April 2011 and 31 March 2012.

These analyses do not include any data about individual patients, nor do they contain any patient identifiable data.

Patients included in the audit are those with a primary discharge diagnosis of heart failure, defined by the following ICD-10 codes (the diagnosis codes assigned to patients when they are discharged from hospital):

• 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

This means that the main reason for their admission to hospital was heart failure.

Analyses are published for all hospitals which submitted at least 100 patient records in 2011/12, or achieved at least 70% case ascertainment, measured against Hospital Episode Statistics (HES) data on heart failure admissions.

The analyses contained in the dataset were first published on 27 November 2012 in the National Heart Failure Audit 2011/12 Annual Report.

Analysis from the National Heart Failure Audit requires careful interpretation, and the information should not be looked at in isolation when assessing standards of care. This is the first year for which hospital level analysis has been published, and much of the variation between sites may be down to data quality issues, rather than actual variation in the standard of care. However, publishing this data constitutes an important step towards improving data quality.

Numerators and denominators for the analyses included are not provided. This is because the National Heart Failure Audit Implementation Group decided to refrain from publishing data relating to inpatient mortality until a satisfactory covariate model has been developed to adjust the data for confounding factors (e.g. age and demographics of patient population, severity of symptoms at admission, medical history).

Each year analysis from the National Heart Failure Audit will be made on the data.gov.uk website. The analysis is also included in the National Heart Failure Audit Annual Report, which is publicly available on the NICOR website:

• Current and previous National Heart Failure Audit Annual Reports

The analyses measure clinical practice in the treatment of heart failure in hospitals submitting data to the National Heart Failure Audit. The audit dataset is based on NICE guidelines for the treatment of heart failure, detailed in its Clinical Guideline 108 and Quality Standard 9.

The analyses included are as follows:

• Records submitted: number of records submitted to the audit in 2011/12.
• % received echo: percentage of patients who had an echocardiogram. The denominator for this analysis is all patients.
• % cardiology inpatient: percentage of patients who spent the majority of their time in hospital on a cardiology ward. The denominator for this analysis is all patients.
• % ACEI/ARB on discharge: percentage of patients prescribed an angiotensin converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) on discharge. The denominator for this analysis is all patients with a diagnosis of left ventricular systolic dysfunction (LVSD) who survived to discharge.
• % beta blocker on discharge: percentage of patients prescribed a beta blocker on discharge. The denominator for this analysis is all patients with a diagnosis of left ventricular systolic dysfunction (LVSD) who survived to discharge.
• % referred to HF liaison service: percentage of patients referred to a heart failure nurse led follow-up service on discharge. The denominator for this analysis is all patients with a diagnosis of left ventricular systolic dysfunction (LVSD) who survived to discharge.
• % referred to cardiology follow-up: percentage of patients referred to a cardiologist-led follow-up service on discharge. The denominator for this analysis is all patients who survived to discharge.

More information about the treatment of heart failure in England and Wales, and hospital level analysis for Welsh hospitals can be found in the National Heart Failure Audit 2011/12 Annual Report.

• National Heart Failure Audit 2011/12 Annual Report (pdf)

The analysis is reported at hospital level, for every hospital in England which admitted patients with acute heart failure in 2011/12. Welsh hospitals are not included in the analyses published on data.gov.uk, but analyses for Welsh hospitals can be found in the National Heart Failure Audit Annual Reports.

Analyses are included for every eligible hospital which submitted at least 100 patient records, or records from 70% of all of their heart failure patients, to the audit. Case ascertainment is measured against HES recorded heart failure admissions.

Those hospitals submitting fewer data than this were excluded because the National Heart Failure Audit Project Board deemed the numbers in such cases to be too low to produce accurate analysis. An asterisk (*) in the data file replaces excluded data; 29 hospitals had analyses excluded due to a small number of records. A blank cell indicates that a hospital submitted no data; 21 hospitals in England submitted no data to the audit in 2011/12.

The analyses cover the period from 01/04/2011 to 31/03/2012.