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Heart failure improvement measures

Creating the cohorts

Proportion of patients with heart failure who have an echocardiogram recorded (ever)

Definition	Proportion of patients* with heart failure who have an echocardiogram recorded (ever)
Inclusion criteria	Patients with heart failure Patients must have a record of being referred for or having received an echocardiogram (ever)
Exclusion criteria	N/A
Rationale	An echocardiogram is the single most useful investigation in heart failure, as it will confirm the diagnosis and inform future management strategies.¹
Calculation instructions	NPS MedicineWise is working with others in the primary care data space to develop assistance in calculating this measure. Data audit tools extract and analyse practice-level data. Your PHN should be your point of contact for advice and training.

*Include all patients with a reference to heart failure whether they qualify for the RACGP definition of an active patient or not.

Proportion of patients with heart failure who have classification of heart failure recorded (ever): reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF)

Definition	Proportion of patients* with heart failure who have classification of heart failure recorded (ever)
Inclusion criteria	Patients with heart failure Patients must have a record of heart failure classification; either heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF)
Exclusion criteria	N/A
Rationale	Identifying and recording the classification of heart failure (HFrEF or HFpEF) based on left ventricular ejection fraction (LVEF) is important as it guides effective treatment.^1,7

*Include all patients with a reference to heart failure whether they qualify for the RACGP definition of an active patient or not.

Calculation instructions

Proportion of patients with heart failure who have a GPMP/TCA or CVC program developed or reviewed in the last 12 months

Definition	Proportion of patients* with heart failure who have a GP Management Plan (GPMP) or Team Care Arrangement (TCA) or a Coordinated Veteran’s Care (CVC) program developed or reviewed in the last 12 months
Inclusion criteria	Patients with heart failure Patients must have a record of a GPMP, or TCA or CVC program developed or reviewed in the last 12 months
Exclusion criteria	N/A
Rationale	Referral to a multidisciplinary heart failure management program is recommended in patients with heart failure associated with high-risk features, to decrease mortality and rehospitalisation.¹

*Include all patients with a reference to heart failure whether they qualify for the RACGP definition of an active patient or not.

Calulation instructions

Proportion of patients with heart failure who have been referred for an Home Medication Review (HMR) or Residential Medication Management Review (RMMR) in the last 12 months

Definition	Proportion of patients* with heart failure who have had a Home Medicines Review (HMR) or Residential Medication Management Review (RMMR) in the last 12 months
Inclusion criteria	Patients with heart failure Patients must have a record of having an HMR/ RMMR developed or reviewed in the last 12 months
Exclusion criteria	N/A
Rationale	In patients with heart failure, HMRs were found to reduce the likelihood of hospitalisation by 46%. ⁸

*Include all patients with a reference to heart failure whether they qualify for the RACGP definition of an active patient or not.

Calculation instructions

Proportion of patients with heart failure vaccinated against influenza disease in the last 12 months

Definition	Proportion of patients* with heart failure vaccinated against influenza disease in the last 12 months
Inclusion criteria	Patients with heart failure Patients must have a record of having received a vaccination against influenza disease in the last 12 months
Exclusion criteria	N/A
Rationale	Heart failure patients are at increased risk of respiratory infection and such infections are a major cause of decompensation. Patients should be vaccinated against influenza disease. There is evidence suggesting influenza vaccination may have a protective effect in heart failure. ¹
Calculation instructions	NPS MedicineWise is working with others in the primary care data space to develop assistance in calculating this measure. Data audit tools extract and analyse practice-level data. Your PHN should be your point of contact for advice and training.

*Include all patients with a reference to heart failure whether they qualify for the RACGP definition of an active patient or not.

Proportion of patients with heart failure vaccinated against pneumococcal disease (ever)

Definition	Proportion of patients* with heart failure vaccinated against pneumococcal disease (ever)
Inclusion criteria	Patients with heart failure Patients must have a record of having received a vaccination against pneumococcal disease (ever)
Exclusion criteria	N/A
Rationale	Heart failure patients are at increased risk of respiratory infection and such infections are a major cause of decompensation. Patients should be vaccinated against pneumococcal disease. There is evidence suggesting pneumococcal vaccination may have a protective effect in heart failure.¹
Calculation instructions	NPS MedicineWise is working with others in the primary care data space to develop assistance in calculating this measure. Data audit tools extract and analyse practice-level data. Your PHN should be your point of contact for advice and training.

*Include all patients with a reference to heart failurewhether they qualify for the RACGP definition of an active patient or not.

Proportion of patients with HFrEF currently prescribed an ACE inhibitor, ARB or ARNI

Definition	Proportion of patients* with HFrEF currently prescribed an ACE inhibitor, ARB or an ARNI
Inclusion criteria	Patients with heart failure Patients must have a record of being currently prescribed an ACE inhibitor, ARB or an ARNI
Exclusion criteria	Patients with a recorded classification of HFpEF
Rationale	An ACE inhibitor is recommended in all patients with HFrEF associated with a moderate or severe reduction in LVEF (LVEF less than or equal to 40%) to decrease mortality and decrease hospitalisation unless contraindicated or not tolerated. ¹ An ARB is recommended if an ACE inhibitor is contraindicated or not tolerated to decrease the combined endpoint of cardiovascular mortality and hospitalisation for heart failure. ¹ An ARNI is recommended as a replacement for an ACE inhibitor (or ARB) with a heart failure beta blocker (unless contraindicated), with or without an MRA, to decrease mortality and decrease hospitalisation.¹
Calculation instructions	NPS MedicineWise is working with others in the primary care data space to develop assistance in calculating this measure. Data audit tools extract and analyse practice-level data. Your PHN should be your point of contact for advice and training.

*Include all patients with a reference to heart failure whether they qualify for the RACGP definition of an active patient or not.

Proportion of patients with HFrEF currently prescribed a heart failure beta blocker

Definition	Proportion of patients* with HFrEF currently prescribed a heart failure beta blocker
Inclusion criteria	Patients with heart failure Patients must have a record of being currently prescribed a heart failure beta blocker
Exclusion criteria	Patients with a recorded classification of HFpEF
Rationale	A heart failure beta blocker is recommended in all patients with HFrEF associated with a moderate or severe reduction in LVEF (LVEF less than or equal to 40%) to decrease mortality and decrease hospitalisation unless contraindicated or not tolerated and once stabilised with no or minimal clinical congestion on physical examination.¹
Calculation instructions	NPS MedicineWise is working with others in the primary care data space to develop assistance in calculating this measure. Data audit tools extract and analyse practice-level data. Your PHN should be your point of contact for advice and training.

*Include all patients with a reference to heart failure whether they qualify for the RACGP definition of an active patient or not.

Proportion of patients with HFrEF currently prescribed an MRA

Definition	Proportion of patients* with HFrEF currently prescribed an MRA
Inclusion criteria	Patients with HFrEF Patients must have a record of being currently prescribed an MRA
Exclusion criteria	Patients with a recorded classification of HFpEF
Rationale	An MRA is recommended in all patients with HFrEF associated with a moderate or severe reduction in LVEF (LVEF less than or equal to 40%) unless contraindicated or not tolerated to decrease mortality and decrease hospitalisation.¹
Calculation instructions	NPS MedicineWise is working with others in the primary care data space to develop assistance in calculating this measure. Data audit tools extract and analyse practice-level data. Your PHN should be your point of contact for advice and training.

*Include all patients with a reference to heart failure whether they qualify for the RACGP definition of an active patient or not.

Proportion of patients with HFrEF currently prescribed a combination of an ACE inhibitor, ARB or ARNI + heart failure beta blocker + MRA

Definition	Proportion of patients* with HFrEF currently prescribed an ACE inhibitor, ARB or ARNI + heart failure beta blocker + MRA
Inclusion criteria	Patients with HFrEF Patients must have a record of being currently prescribed an ACE inhibitor, ARB or ARNI + heart failure beta blocker + MRA
Exclusion criteria	Patients with a recorded classification of HFpEF
Rationale	The cornerstone of pharmacotherapy for HFrEF comprises ACE inhibitor or angiotensin receptor blocker (ARBs) if the patient is intolerant of ACE inhibitors, followed by heart failure beta blockers then mineralocorticoid receptor antagonists (MRAs) then angiotensin receptor neprilysin inhibitors (ARNIs). ¹
Calculation instructions	NPS MedicineWise is working with others in the primary care data space to develop assistance in calculating this measure. Data audit tools extract and analyse practice-level data. Your PHN should be your point of contact for advice and training.

*Include all patients with a reference to heart failure whether they qualify for the RACGP definition of an active patient or not.

ACE inhibitor: angiotensin-converting enzyme inhibitor, ARB: angiotensin receptor blocker, ARNI: angiotensin receptor neprilysin inhibitor, MRA: mineralocorticoid receptor antagonist

Proportion of patients with HFrEF currently prescribed target dose of an ACE inhibitor, ARB or ARNI following 6 months commencement of medicine

Definition	Proportion of patients* with HFrEF currently prescribed an ACE inhibitor, ARB or ARNI at target dose following 6 months commencement of medicine
Inclusion criteria	Patients with HFrEF Patients must be currently prescribed an ACE inhibitor, ARB or ARNI Patients must be currently prescribed an ACE inhibitor, ARB or ARNI at target dose following 6 months commencement of medicine
Exclusion criteria	Patients with a recorded classification of HFpEF
Rationale	The combination of an ACE inhibitor + heart failure beta blocker + MRA would decrease mortality over 1-3 years 50-60%. Clinicians should aim for the target doses used in the RCT that showed the benefit of the medicines. An ARNI has been shown to further decrease mortality compared to an ACE inhibitor in patients with persistent HFrEF despite current best practice (including a beta blocker and ACE inhibitor or ARB with or without an MRA).¹
Calculation instructions	NPS MedicineWise is working with others in the primary care data space to develop assistance in calculating this measure. Data audit tools extract and analyse practice-level data. Your PHN should be your point of contact for advice and training.

For information about target doses visit: Clinical fact sheet: pharmacological management of chronic heart failure with reduced ejection fraction (HFrEF).

*Include all patients with a reference to heart failure whether they qualify for the RACGP definition of an active patient or not.

Proportion of patients with HFrEF currently prescribed a heart failure beta blocker at target dose following 6 months commencement of medicine

Definition	Proportion of patients* with HFrEF currently prescribed a heart failure beta blocker at target dose following 6 months commencement of medicine
Inclusion criteria	Patients with heart failure Patients must be currently prescribed a heart failure beta blocker Patients must be currently prescribed target dose following 6 months commencement of medicine
Exclusion criteria	Patients with a recorded classification of HFpEF
Rationale	The combination of an ACE inhibitor + heart failure beta blocker + MRA would decrease mortality over 1-3 years 50-60%. Clinicians should aim for the target doses used in the RCT that showed the benefit of the medicines.¹
Calculation instructions	NPS MedicineWise is working with others in the primary care data space to develop assistance in calculating this measure. Data audit tools extract and analyse practice-level data. Your PHN should be your point of contact for advice and training.

For information about target doses visit: Clinical fact sheet: pharmacological management of chronic heart failure with reduced ejection fraction (HFrEF).

*Include all patients with a reference to heart failure whether they qualify for the RACGP definition of an active patient or not.

Proportion of patients with heart failure reviewed within 2 weeks following hospital discharge

Definition	Proportion of patients* with heart failure reviewed within 2 weeks following hospital discharge
Inclusion criteria	Patients with heart failure Patients must have been hospitalised for heart failure Patients must have been reviewed within 2 weeks following hospital discharge
Exclusion criteria	N/A
Rationale	Prospective studies and regulatory data have shown that the most vulnerable period for patients with heart failure is within the first few weeks post- hospital discharge. Ideally these patients should be reviewed within the first 7-14 days of hospital discharge. ¹
Calculation instructions	NPS MedicineWise is working with others in the primary care data space to develop assistance in calculating this measure. Data audit tools extract and analyse practice-level data. Your PHN should be your point of contact for advice and training.

*Include all patients with a reference to heart failure whether they qualify for the RACGP definition of an active patient or not.

Proportion of patients with heart failure currently prescribed medicines that can worsen heart failure

Definition	Proportion of patients* with heart failure currently prescribed a non-steroidal anti-inflammatory drug (NSAID), cyclo-oxygenase inhibitor (COX-2 inhibitor), diltiazem or verapamil, oral corticosteroid, tricyclic antidepressant (TCA).
Inclusion criteria	Patients with heart failure Patients must have a record of a NSAID or COX-2 inhibitor or diltiazem or verapamil or an oral corticosteroid or a TCA in their current medicine list.
Exclusion criteria	N/A
Rationale	Non-steroidal anti-inflammatory drugs (NSAIDs), cyclo-oxygenase inhibitors (COX-2 inhibitor), diltiazem, verapamil, oral corticosteroid and tricyclic antidepressants (TCAs) can worsen symptoms in patients with heart failure.¹
Calculation instructions	NPS MedicineWise is working with others in the primary care data space to develop assistance in calculating this measure. Data audit tools extract and analyse practice-level data. Your PHN should be your point of contact for advice and training.

*Include all patients with a reference to heart failure whether they qualify for the RACGP definition of an active patient or not.

References

Date reviewed: 17 June 2021

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