HF003 - Heart Failure on ACEi or ARB

HF003 - Heart Failure on ACEi or ARB

The information contained within this article is from version 49 of the Business Rules for Quality and Outcomes Framework (QOF).                                                                     

Indicator definition

Indicator ID

Description

In those patients with a diagnosis of heart failure due to left ventricular systolic dysfunction or whose heart failure is due to reduced ejection fraction, the percentage of patients who are currently treated with an angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blockers (ARB).

What do the business rules mean?

What makes a patient eligible?

Patients are eligible for the HF003 denominator if:
  1. they are on the Heart Failure register
    and
  2. they have a Left Ventricular Systolic Dysfunction or reduced ejection fraction code
It is worth reviewing patients who have an unresolved heart failure diagnosis to see if they should also have a Left Ventricular Systolic Dysfunction (LVSD) or reduced ejection fraction code, as if they are already on an beta-blocker (likely) this will boost your performance in this area.

How to achieve the indicator

To meet the criteria for HF003, eligible patients must have had:
  1. an ACEi or ARB prescription issued within 6 months of the end of the contract year

What will remove patients from eligibility?

  1. Patients for whom heart failure quality indicator care was unsuitable in the contract year
  2. Patients who meet at least one of the criteria from Group 1 and at least 1 of the criteria from Group 2:
    1. Group 1

      1. a persisting contraindication to an ACEi anywhere in their record (or)

      2. an expiring contraindication to an ACEi recorded in the contract year (or)

      3. have chosen not to receive an ACEi in the contract year

    2. Group 2

      1. a persisting contraindication to an ARB anywhere in their record (or)

      2. an expiring contraindication to an ARB recorded in the contract year (or)

      3. have chosen not to receive an ARB in the contract year

  3. Patients who have chosen not to receive heart failure quality indicator care in the contract year
  4. Patients who have been invited twice (at least 7 days apart) for review
  5. Patients who were diagnosed with diabetes in the last 3 months of the contract year
  6. Patients who were newly registered with the practice in the last 3 months of the contract year
If a patient achieves the indicator at any point during the year, any exclusions that have also been added are ignored.

SNOMED codes used in this indicator

The codes referenced in this article are taken from the NHS Technology Reference Update Distribution (TRUD).  Not all of these may be present or selectable in all clinical systems.

Codes for heart failure due to left ventricular systolic dysfunction (LVSD) (HFLVSD_COD)

SNOMED code

SNOMED code description

134401001

Left ventricular systolic dysfunction

407596008
Echocardiogram shows left ventricular systolic dysfunction
426263006
Congestive heart failure due to left ventricular systolic dysfunction
430396006
Chronic systolic dysfunction of left ventricle
698592004
Asymptomatic left ventricular systolic dysfunction

Reduced ejection fraction (heart failure) codes (REDEJCFRAC_COD)

SNOMED code

SNOMED code description

703272007

Heart failure with reduced ejection fraction

703273002
Heart failure with reduced ejection fraction due to coronary artery disease
703274008
Heart failure with reduced ejection fraction due to myocarditis
703275009
Heart failure with reduced ejection fraction due to cardiomyopathy
703276005
Heart failure with reduced ejection fraction due to heart valve disease

Angiotensin-converting enzyme (ACE) inhibitor contraindications (persisting) (XACE_COD)

SNOMED code

SNOMED code description

18321000122100

Non-allergic hypersensitivity to benazepril

18361000122109
Non-allergic hypersensitivity to moexipril
18401000122101
Non-allergic hypersensitivity to imidapril
293500009
Angiotensin-converting-enzyme inhibitor adverse reaction
293501008
Captopril adverse reaction
293502001
Lisinopril adverse reaction
293503006
Quinapril adverse reaction
293504000
Ramipril adverse reaction
293505004
Cilazapril adverse reaction
293506003
Trandolapril adverse reaction
293507007
Enalapril adverse reaction
293508002
Fosinopril adverse reaction
293509005
Perindopril adverse reaction
371627004
Angiotensin converting enzyme inhibitor-aggravated angioedema
422593004
Acute renal failure caused by angiotensin-converting-enzyme inhibitor
609537003
Non-allergic hypersensitivity to angiotensin-converting enzyme inhibitor
609538008
Non-allergic hypersensitivity to captopril
609539000
Non-allergic hypersensitivity to cilazapril
609540003
Non-allergic hypersensitivity to enalapril
609541004
Non-allergic hypersensitivity to fosinopril
609542006
Non-allergic hypersensitivity to lisinopril
609543001
Non-allergic hypersensitivity to perindopril
609544007
Non-allergic hypersensitivity to quinapril
609545008
Non-allergic hypersensitivity to ramipril
609546009
Non-allergic hypersensitivity to trandolapril
609550002
History of angiotensin converting enzyme inhibitor pseudoallergy

Angiotensin-converting enzyme (ACE) inhibitor contraindications (expiring) (TXACE_COD)

SNOMED code

SNOMED code description

134390006

Angiotensin converting enzyme inhibitor not indicated

315364008
Angiotensin converting enzyme inhibitors contraindicated
407564000
Angiotensin converting enzyme inhibitor not tolerated

Angiotensin II receptor blockers (ARB) contraindications (persisting) (XAII_COD)

SNOMED code

SNOMED code description

293513003

Adverse reaction caused by losartan

407590002
Angiotensin II receptor antagonist adverse reaction
609534005
Non-allergic hypersensitivity to losartan
609549002
Non-allergic hypersensitivity to angiotensin II receptor antagonist
720672008
Adverse reaction caused by telmisartan
720673003
Adverse reaction caused by valsartan
720674009
Adverse reaction caused by olmesartan
720675005
Adverse reaction caused by irbesartan
720676006
Adverse reaction caused by eprosartan
720677002
Adverse reaction caused by candesartan
720678007
Adverse reaction caused by azilsartan

Angiotensin II receptor blockers (ARB) contraindications (expiring) (TXAII_COD)

SNOMED code

SNOMED code description

394987009

Angiotensin II receptor antagonists contraindicated

407565004
Angiotensin II receptor antagonist not tolerated
407572003
Angiotensin II receptor antagonist not indicated

Codes for heart failure quality indicator care unsuitable for patient (HFPCAPU_COD)

SNOMED code

SNOMED code description

717481000000104

Excepted from heart failure quality indicators - patient unsuitable

Codes indicating the patient has chosen not to receive angiotensin-converting enzyme (ACE) inhibitor (ACEDEC_COD)

SNOMED code

SNOMED code description

134397009

Angiotensin converting enzyme inhibitor declined

Codes indicating the patient has chosen not to receive angiotensin II receptor blockers (ARB) (AIIDEC_COD)

SNOMED code

SNOMED code description

401084003

Angiotensin II receptor antagonist declined

Codes indicating the patient has chosen not to receive heart failure quality indicator care (HFPCADEC_COD)

SNOMED code

SNOMED code description

717491000000102

Excepted from heart failure quality indicators - informed dissent

Invite for heart failure care review codes (HFINVITE_COD)

SNOMED code

SNOMED code description

1109921000000106

Quality and Outcomes Framework quality indicator-related care invitation

1110931000000103
Quality and Outcomes Framework heart failure quality indicator-related care invitation
143411000000100
Quality and Outcomes Framework heart failure quality indicator-related care invitation using preferred method of communication
711461000000104
Heart failure monitoring invitation
716621000000101
Heart failure monitoring third letter
716971000000109
Heart failure monitoring first letter
717191000000108
Heart failure monitoring second letter
717501000000108
Heart failure monitoring verbal invitation
717531000000102
Heart failure monitoring telephone invitation










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