HF009 - Heart Failure on 4 pillars
The information contained within this article is from version 51 of the Business Rules for Quality and Outcomes Framework (QOF).
Indicator definition
Indicator ID | Description |
The percentage of patients with a current diagnosis of heart failure with reduced ejection fraction, who are currently treated with: an angiotensin-converting enzyme inhibitor or angiotensin receptor-neprilysin inhibitor or angiotensin II receptor blocker and a beta blocker licensed for heart failure and a mineralocorticoid receptor antagonist and a sodium glucose co-transporter-2 inhibitor. |
What do the business rules mean?
What makes a patient eligible?
Patients are eligible for the HF007 denominator if they are on the Heart Failure register HF3_REG which stipulates:
- Heart failure diagnosis
- Without a resolved code
- With reduced ejection fraction code
How to achieve the indicator
To meet the criteria for HF009, eligible patients must have been prescribed (within 6 months of the end of the contract year):
- An ACEi/ARB/ARNI
- A licensed beta-blocker
- A mineralocorticoid receptor antagonist
- An SGLT2 inhibitor
What will remove patients from eligibility?
- Patients who are on:
- An ACEi/ARB/ARNI
- A mineralocorticoid receptor antagonist
- An SGLT2 inhibitor
- A unlicensed beta blocker which was issued in the 6 months before the patients heart failure diagnosis
- Any combination of prescribed/persisting contraindication (any time)/expiring contraindication (in year) or patient chose not to receive the following:
- An ACEI (persisting contraindication / expiring contraindication / chose not to receive)
- An ARB (persisting contraindication / expiring contraindication / chose not to receive)
- An ARNI (persisting contraindication / expiring contraindication / chose not to receive)
- A licensed beta blocker (persisting contraindication / expiring contraindication / chose not to receive)
- A mineralocorticoid antagonist (persisting contraindication / expiring contraindication / chose not to receive)
- An SGL2 inhibitor (persisting contraindication / expiring contraindication / chose not to receive)
- Patients for whom heart failure quality indicator care was unsuitable in the contract year
- Patients who chose not to receive heart failure quality indicator care in the contract year
- Patients who have been invited twice (at least 7 days apart) within the contract year
- Patients who were diagnosed with heart failure in the last 3 months of the contract year
- 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 reduced ejection fraction (REDEJCFRAC_COD)
| Code | Display |
|---|---|
| 703273002 | Heart failure with reduced ejection fraction due to coronary artery disease |
| 703276005 | Heart failure with reduced ejection fraction due to heart valve disease |
| 703275009 | Heart failure with reduced ejection fraction due to cardiomyopathy |
| 703272007 | Heart failure with reduced ejection fraction |
| 703274008 | Heart failure with reduced ejection fraction due to myocarditis |
Codes for persisting ACEi contraindication (XACE_COD)
| Code | Display |
|---|---|
| 609537003 | Non-allergic hypersensitivity to angiotensin-converting enzyme inhibitor |
| 609540003 | Non-allergic hypersensitivity to enalapril |
| 18401000122101 | Non-allergic hypersensitivity to imidapril |
| 609545008 | Non-allergic hypersensitivity to ramipril |
| 609543001 | Non-allergic hypersensitivity to perindopril |
| 293507007 | Enalapril adverse reaction |
| 293502001 | Lisinopril adverse reaction |
| 609546009 | Non-allergic hypersensitivity to trandolapril |
| 609542006 | Non-allergic hypersensitivity to lisinopril |
| 293503006 | Quinapril adverse reaction |
| 293508002 | Fosinopril adverse reaction |
| 609538008 | Non-allergic hypersensitivity to captopril |
| 609539000 | Non-allergic hypersensitivity to cilazapril |
| 293501008 | Captopril adverse reaction |
| 422593004 | Acute renal failure caused by angiotensin-converting-enzyme inhibitor |
| 18361000122109 | Non-allergic hypersensitivity to moexipril |
| 371627004 | ACE inhibitor-aggravated angioedema |
| 18321000122100 | Non-allergic hypersensitivity to benazepril |
| 609541004 | Non-allergic hypersensitivity to fosinopril |
| 293504000 | Ramipril adverse reaction |
| 293509005 | Perindopril adverse reaction |
| 293505004 | Cilazapril adverse reaction |
| 609550002 | H/O: angiotensin converting enzyme inhibitor pseudoallergy |
| 293506003 | Trandolapril adverse reaction |
| 609544007 | Non-allergic hypersensitivity to quinapril |
| 293500009 | Angiotensin-converting-enzyme inhibitor adverse reaction |
Codes for expiring ACEi contraindication (TXACE_COD)
| Code | Display |
|---|---|
| 315364008 | Angiotensin converting enzyme inhibitors contraindicated |
| 134390006 | Angiotensin converting enzyme inhibitor not indicated |
| 407564000 | Angiotensin converting enzyme inhibitor not tolerated |
Codes for patients chose not to receive ACEi (ACEDEC_COD)
| Code | Display |
|---|---|
| 134397009 | Angiotensin converting enzyme inhibitor declined |
Codes for persisting ARB contraindication (XAII_COD)
| Code | Display |
|---|---|
| 720674009 | Adverse reaction caused by olmesartan |
| 720672008 | Adverse reaction caused by telmisartan |
| 720678007 | Adverse reaction caused by azilsartan |
| 720673003 | Adverse reaction caused by valsartan |
| 720675005 | Adverse reaction caused by irbesartan |
| 720677002 | Adverse reaction caused by candesartan |
| 407590002 | Angiotensin II receptor antagonist adverse reaction |
| 609549002 | Non-allergic hypersensitivity to angiotensin II receptor antagonist |
| 720676006 | Adverse reaction caused by eprosartan |
| 293513003 | Adverse reaction caused by losartan |
| 609534005 | Non-allergic hypersensitivity to losartan |
Codes for expiring ARB contraindication (TXAII_COD)
| Code | Display |
|---|---|
| 394987009 | Angiotensin II receptor antagonists contraindicated |
| 407572003 | Angiotensin II receptor antagonist not indicated |
| 407565004 | Angiotensin II receptor antagonist not tolerated |
Codes for patients chose not to receive ARB (AIIDEC_COD)
| Code | Display |
|---|---|
| 401084003 | Angiotensin II receptor antagonist declined |
Codes for persisting ARNI contraindication
Codes not currently available
Codes for expiring ARNI contraindication
Codes not currently available
Codes for patients chose not to receive ARNI
Codes not currently available
Codes for persisting beta blocker contraindication (XLBB_COD)
| Code | Display |
|---|---|
| 292441005 | Sotalol adverse reaction |
| 292420004 | Cardioselective beta-blocker adverse reaction |
| 292432000 | SNOMED CT 292432000 |
| 292439009 | Practolol adverse reaction |
| 293975009 | Allergy to metipranolol |
| 1053601000000108 | Nebivolol adverse reaction |
| 292433005 | Metipranolol adverse reaction |
| 292429003 | Non-cardioselective beta-blocker adverse reaction |
| 772020009 | Adverse reaction to nebivolol |
| 293978006 | Allergy to levobunolol |
| 293979003 | Allergy to oxprenolol |
| 419869001 | Atenolol sensitivity |
| 293981001 | Allergy to practolol |
| 293973002 | Allergy to pindolol |
| 720665007 | Adverse reaction caused by metoprolol succinate |
| 292442003 | Timolol adverse reaction |
| 293965006 | Allergy to atenolol |
| 293962009 | Allergy to beta adrenergic receptor antagonist |
| 1269396003 | Hypersensitivity to atenolol |
| 292430008 | Nadolol adverse reaction |
| 293974008 | Allergy to carvedilol |
| 292427001 | Esmolol adverse reaction |
| 292421000 | Acebutolol adverse reaction |
| 292428006 | Metoprolol adverse reaction |
| 293976005 | Allergy to carteolol |
| 772021008 | Allergy to nebivolol |
| 293977001 | Allergy to labetalol |
| 292440006 | Propranolol adverse reaction |
| 292435003 | Labetalol adverse reaction |
| 293964005 | Allergy to acebutolol |
| 1053591000000102 | Nebivolol allergy |
| 293983003 | Allergy to sotalol |
| 293967003 | Allergy to bisoprolol |
| 293969000 | Allergy to esmolol |
| 292424008 | Betaxolol adverse reaction |
| 292436002 | Levobunolol adverse reaction |
| 292426005 | Celiprolol adverse reaction |
| 293970004 | Allergy to metoprolol |
| 418370000 | Atenolol adverse reaction |
| 293984009 | Allergy to timolol |
| 720666008 | Adverse reaction caused by metoprolol tartrate |
| 292434004 | Carteolol adverse reaction |
| 292437006 | Oxprenolol adverse reaction |
| 292431007 | Pindolol adverse reaction |
| 292419005 | Beta-adrenoceptor blocking drug adverse reaction |
| 292438001 | Penbutolol adverse reaction |
| 293982008 | Allergy to propranolol |
| 292425009 | Bisoprolol adverse reaction |
| 293980000 | Allergy to penbutolol |
| 293971000 | Non-cardioselective beta-blocker allergy |
| 293963004 | Allergy to beta-1 adrenergic receptor antagonist |
| 293966007 | Allergy to betaxolol |
| 293972007 | Allergy to nadolol |
| 293968008 | Allergy to celiprolol |
Codes for expiring beta blocker contraindication (TXLBB_COD)
| Code | Display |
|---|---|
| 698468005 | Bisoprolol contraindicated |
| 508831000000101 | Bisoprolol not tolerated |
| 736004008 | Nebivolol contraindicated |
| 874932008 | Carvedilol not indicated |
| 88201000000105 | Beta blocker not tolerated |
| 508861000000106 | Carvedilol not tolerated |
| 736006005 | Carvedilol contraindicated |
| 874934009 | Bisoprolol not indicated |
| 508741000000103 | Bisoprolol not indicated |
| 315062004 | Beta blocker contraindicated |
| 508891000000100 | Nebivolol not tolerated |
| 315214003 | Beta blocker not indicated |
| 508771000000109 | Carvedilol not indicated |
| 508801000000107 | Nebivolol not indicated |
| 874933003 | Nebivolol not indicated |
Codes for patients chose not to receive beta blocker (LBBDEC_COD)
| Code | Display |
|---|---|
| 508951000000103 | Carvedilol therapy refused |
| 698758004 | Nebivolol therapy declined |
| 315020006 | Beta blocker therapy declined |
| 508921000000108 | Bisoprolol therapy refused |
Codes for persisting mineralocorticoid contraindication (XMRADRUG_COD)
| Code | Display |
|---|---|
| 293472002 | Spironolactone adverse reaction |
| 295009002 | Allergy to spironolactone |
Codes for expiring mineralocorticoid contraindication (TXMRADRUG_COD)
| Code | Display |
|---|---|
| 109981000000107 | Spironolactone contraindicated |
| 809531000000105 | Eplerenone contraindicated |
Codes for patients chose not to receive mineralocorticoid (MRADRUGDEC_COD)
| Code | Display |
|---|---|
| 280411000000101 | Spironolactone declined |
| 819001000000107 | Eplerenone therapy declined |
Codes for persisting SGLT2i contraindication (XSGLT2IDRUG_COD)
| Code | Display |
|---|---|
| 1208353007 | Allergy to dapagliflozin |
| 1208355000 | Allergy to canagliflozin |
Codes for expiring SGLT2i contraindication (TXSGLT2IDRUG_COD
| Code | Display |
|---|---|
| 2570471000000107 | Sodium-glucose co-transporter-2 inhibitor contraindicated |
| 2570491000000106 | Sodium-glucose co-transporter-2 inhibitor not indicated |
Codes for patients chose not to receive SGLT2i (SGLT2DRUGDEC_COD)
| Code | Display |
|---|---|
| 2570461000000100 | Sodium-glucose co-transporter-2 inhibitor declined |
Codes for heart failure quality indicator care unsuitable for patient (HFPCAPU_COD)
| Code | Display |
|---|---|
| 717481000000104 | Excepted from heart failure quality indicators - patient unsuitable |
Codes indicating the patient has chosen not to receive heart failure quality indicator care (HFPCADEC_COD)
| Code | Display |
|---|---|
| 717491000000102 | Excepted from heart failure quality indicators - informed dissent |
Invite for heart failure care review codes (HFINVITE_COD)
| Code | Display |
|---|---|
| 717501000000108 | Heart failure monitoring verbal invitation |
| 1109921000000106 | QOF (Quality and Outcomes Framework) quality indicator-related care invitation |
| 143411000000100 | QOF (Quality and Outcomes Framework) heart failure quality indicator-related care invitation using preferred method of communication |
| 717531000000102 | Heart failure monitoring telephone invitation |
| 716621000000101 | Heart failure monitoring third letter |
| 1110931000000103 | QOF (Quality and Outcomes Framework) heart failure quality indicator-related care invitation |
| 716971000000109 | Heart failure monitoring first letter |
| 717191000000108 | Heart failure monitoring second letter |
| 711461000000104 | Heart failure monitoring invitation |
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