QOF

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Patient population with heart failure due to LVSD*

*N.B. Codes required to be present from both groups to qualify a patient for inclusion

Heart Failure

G58.. Heart failure
G580. Congestive heart failure
G5800 Acute congestive heart failure
G5801 Chronic congestive heart failure
G5802 Decompensated cardiac failure
G5803 Compensated cardiac failure
G5804 Congestive heart failure due to valvular disease
G581. Left ventricular failure
G5810 Acute left ventricular failure
G582. Acute heart failure
G583. Heart failure with normal ejection fraction
G584. Right ventricular failure
G58z. Heart failure NOS
G1yz1 Rheumatic left ventricular failure
662f. New York Heart Association classification - class I (v9)
662g. New York Heart Association classification - class II (v9)
662h. New York Heart Association classification - class III (v9)
662i. New York Heart Association classification - class IV (v9)
 

Codes for LVSD

585f. Echocardiogram shows left ventricular systolic dysfunction
G5yy9 Left ventricular systolic dysfunction
G5yyD Left ventricular cardiac dysfunction

Exclusion codes (Every 12 months)

9hH.. Exception reporting: heart failure quality indicators
9hH0. Excepted from heart failure quality indicators: Patient unsuitable
9hH1. Excepted from heart failure quality indicators: Informed dissent
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Ace inhibitor contraindications; persistent

14LM. H/O: angiotensin converting enzyme inhibitor allergy
U60C4 [X]Angiotensin-converting-enzyme inhibitors causing adverse effects in therapeutic use
ZV14D [V]Personal history of angiotensin-converting-enzyme inhibitor allergy
TJC77 Adverse reaction to captopril
TJC78 Adverse reaction to enalapril
TJC79 Adverse reaction to ramipril

K0430 Acute renal failure due to ACE inhibitor (v26)

Ace inhibitor contraindications; expiring (12 months)

8I28. Angiotensin converting enzyme inhibitors contraindicated
8I3D. Angiotensin converting enzyme inhibitor declined
8I64. Angiotensin converting enzyme inhibitor not indicated
8I74. Angiotensin converting enzyme inhibitor not tolerated

AII antagonist contraindications: persisting

14LN. H/O: angiotensin II receptor antagonist allergy
U60CB [X]Angiotensin II receptor antagonists causing adverse effects in therapeutic use
ZV14E [V]Personal history of angiotensin II receptor antagonist allergy

AII antagonist contraindications: expiring (12 months)

8I2H. Angiotensin II receptor antagonists contraindicated
8I3P. Angiotensin II receptor antagonist declined
8I6C. Angiotensin II receptor antagonist not indicated
8I75. Angiotensin II receptor antagonist not tolerated

Ace inhibitor prescription codes (prescribed in the last 6 months)

bi...%
bA…%
bk6..%

AII antagonist prescription codes (prescribed in the last 6 months)

bk3.. - bk5z.
bk7.. - bk9z.
bkB..%
bkC..%
bkD..%
bkI..%
bkH..%
bkJ..%
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Heart failure 003.1 Rationale

There is strong clinical and cost effectiveness evidence to support the use of ACE inhibitors in all patients with heart failure with LVD. ACE inhibitors improve symptoms, reduce hospitalisation rate, and improve survival rate. This is applicable in all age groups. ARBs are also effective in the treatment of patients with heart failure and LVD but, as recommended below, they should be used only in patients intolerant of ACE inhibitors.

It should also be noted that it is possible to have a diagnosis of LVD without heart failure, for example, asymptomatic people who might be identified coincidentally but who are at high risk of developing subsequent heart failure. In such cases ACE inhibitors delay the onset of symptomatic heart failure, reduce cardiovascular events and improve long-term survival. This indicator only concerns patients with heart failure and thus excludes this other group of patients who should nevertheless be considered for treatment with ACE inhibitors.

NICE clinical guideline CG108 and SIGN clinical guideline 95 recommend that ACE-I is used as first-line therapy in all patients with HF due to LVSD and that ARBs are used only in patients who are intolerant of ACE-I.

Further information:

NICE CG108. Chronic HF: management of chronic HF in adults in primary and secondary care. 2010.
http://guidance.nice.org.uk/CG108/niceguidance/pdf/english (2010)

NICE quality standard. Chronic HF. 2011.
http://www.nice.org.uk/media/D6F/93/CHFQualityStandard.pdf
(2011)

SIGN clinical guideline 95 (2007). Management of chronic heart failure.
http://www.sign.ac.uk/guidelines/fulltext/95/index.html

Heart failure 003.2 Reporting and verification

See indicator wording for requirement criteria.

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Prepared By Jean Keenan