Heart failure (HF) QOF tips

Dr Gavin Jamie offers advice on meeting the targets in this area, plus details of indicators and achievement thresholds for 2013/14.

It should not be too hard to achieve maximum points in the HF domain (Picture: SPL)
It should not be too hard to achieve maximum points in the HF domain (Picture: SPL)

Advice on improving achievement

GP Dr Gavin Jamie writes:

Heart failure is a relative simple area of the QOF and there should not be too much complication needed to gain all of the points available.

Setting up the register should be fairly simple. The most commonly used codes will be starting G58.

As usual the number of patients on the register will determine the payment for each of the other indicators. In the very early years of QOF only those patients who also had ischaemic heart disease were included in the register but this restriction no longer applies.

The first real indicator requires that all patients diagnosed with heart failure since the first of April 2006 should have had the diagnosis confirmed by echocardiogram or specialist opinion between three months before the date of diagnosis and 12 months afterwards.

This should be routine for patients diagnosed at the practice but when patients join the practice it is essential that the echocardiogram is coded after the notes are received. If this has not happened, or there has been no specialist assessment, there is little that the practice can do.

The next indicator is about prescribing of ACE inhibitors or angiotensin antagonists. As usual only prescriptions issued after 1 October will count towards this indicator. A prescription of either will qualify, but if you are exception reporting then two exception codes - one each for ACE inhibitors and A2I will be needed. The threshold for this indicator has increased to 60-100% in England for 2013/14.

The final indicator is complicated to explain, although it should be simpler in practice. It concerns the prescribing of beta blockers such as bisoprolol. Only patients with left ventricular systolic dysfunction and who have been prescribed ACE or A2I qualify for this indicator. The codes (585f and G5yy9) are explicitly about systolic left ventricular dysfunction.

The final indicator relating to referral to an excercise-related rehabilitation programme, has been deferred until 2014/15 in England, but is included in the QOF for this year in Wales.

Current indicators

Heart failure (HF) indicators Points Achievement thresholds

HF001: The contractor establishes and maintains a register of patients with heart failure.

4

 

HF002: The percentage of patients with a diagnosis of heart failure (diagnosed on or after 1 April 2006) which has been confirmed by an echocardiogram or by specialist assessment 3 months before or 12 months (15 months in N Ireland) after entering the register.

6

All UK countries: 50-90%

HF003: In those patients with a current diagnosis of heart failure due to left ventricular systolic dysfunction, the percentage of patients who are currently treated with an ACE-I or ARB.

10

England: 60-100%*

Wales: 50-90%

Scotland: 50-85%

N Ireland: 45-80%

HF004: In those patients with a current diagnosis of heart failure due to left ventricular systolic dysfunction who are currently treated with an ACW-I or ARB, the percentage of patients who are additionally currently treated with a beta-blocker licensed for heart failure.

9

England, Wales & N Ireland: 40-65%

Scotland: 50-75%*

Wales only:
HF100W
The percentage of patients with heart failure diagnosed within the preceding 15 months with a subsequent record of an offer of referral for an exercise-based rehabilitation programme with the preceding 15 months. 

5

40-90%

*Indicates a threshold that has increased for 2013/14 

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