Why do we need NICE Quality Standards for chronic heart failure?

Dr Rani Khatib is a consultant pharmacist in cardiology and cardiovascular research and associate professor at the University of Leeds. As a member of the NICE Guideline Development Group for chronic heart failure (CHF) he recently contributed to the updated Quality Standards for CHF. He spoke to IMI to explain why quality standards are needed and how they can be used to help improve patient care.

As a frontline clinician Dr Khatib is responsible for running a number of clinical services including some innovative cardiology outpatient clinics focussing on risks and medicines optimisation.  He also contributes to a variety of projects in primary care.  In addition, he is actively involved in research concerned with evaluation of person-centred care, adherence and multi-disciplinary care in the cardiovascular arena.  Recently he has developed a particular interest in cardiorenal metabolic services and promises that we will hear more about a “proper multidisciplinary, one-stop approach” designed to deliver holistic care for people with this complex set of inter-related conditions.

Heart failure is a complex syndrome in which cardiac insufficiency “leads to symptoms which can impact hugely on quality of life, including shortness of breath, fatigue, and fluid retention”. It is a chronic condition with a significant mortality and it imposes a huge burden on patients, society and the NHS, he adds.

Guidelines and quality standards   

The NICE guideline on chronic heart failure (NG106) was published in 2018. The guideline contains multiple recommendations about different aspects of the diagnosis and management of chronic heart failure whereas the quality standards (QS 9) are focused on priority areas. The quality standards are built on the both the guideline and some of the NICE technology appraisals that have been published since 2018, explains Dr Khatib. Importantly, the quality standards focus on quality improvement areas and offer “concise, measurable statements” that healthcare personnel can use to audit and assess their services, he says.

Quality standards are limited to a few areas where there is a need for further enhancement or improvement.  Dr Khatib cites Quality Standard number three, as an example:

‘Adults with chronic heart failure who have reduced ejection fraction receive all appropriate medication at target or optimal tolerated doses.’

The quality standard is a simple statement but the rationale is set out next in the document. “I would advise that when you read the quality statement, don’t leave it at that ……. go and read a little bit of the detail around it, which is actually in the quality statement document, and it will tell you a little bit more about what do we mean by ‘appropriate medications’ [and] what do we mean by ‘optimal tolerated doses’, what’s the rationale behind identifying this quality statement and ….. what you should be auditing if you were to look at that”, says Dr Khatib.

About Dr Rani Khatib

Dr Rani Khatib is a Consultant Cardiology Pharmacist at Leeds Teaching Hospitals NHS Trust and Associate Professor at the Leeds Institute for Cardiometabolic Medicine (LICaM), University of Leeds. He served on the Guideline Development Group and the Quality Standards Committee for heart failure. In addition, he is Co-chair of UKCPA Cardiovascular Group, National Clinical Champion for Lipid Optimisation, AHSN, NHSE and is a member of the ESC Task Force on Cardiology Allied Professionals.

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