HP451 Heart Failure Subtype Review Alert

Overview/Purpose

This protocol supports review of patients who are on the heart failure register but do not currently appear to have heart failure with reduced ejection fraction recorded.

Patients with heart failure with reduced ejection fraction may be eligible for the four pillars of heart failure management, so accurate coding and review is important.

What does it do?

The protocol identifies patients who:

• have heart failure recorded
• are not currently recorded as having heart failure with reduced ejection fraction
• may therefore need review of their heart failure coding and management

The alert is suppressed if a non-HFrEF heart failure code, such as heart failure with normal ejection fraction, has been added during the current QOF year.

Why is it important?

Heart failure coding affects both clinical management and QOF reporting.

If a patient has reduced ejection fraction but this is not recorded correctly, they may not be identified for appropriate optimisation of heart failure treatment.

The protocol helps practices identify patients who may need review, so that:

• heart failure type is coded accurately
• echo information is considered
• previous left ventricular dysfunction coding is not missed
• patients who may be eligible for HFrEF management are reviewed appropriately
  

What will the user see?

The alert appears for relevant patients and provides additional information when the user hovers over it.

The hover information may include:

• when the patient was added to the heart failure register
• the date of the latest recorded echo
• the ejection fraction value from the latest echo
• whether left ventricular dysfunction has previously been coded

The alert supports users in deciding whether further review or coding action is needed.

Recommended user action

Users should:

• review the heart failure coding shown in the alert
• check the latest echo information and ejection fraction value
• consider whether the patient has evidence of reduced ejection fraction
• update heart failure coding where clinically appropriate
• use the patient review code to record that the patient has been reviewed, where appropriate
• consider whether heart failure treatment optimisation is needed
  
• double click on the alert to launch a template to record updated information

System Dependencies

This protocol relies on accurate recording of:

• heart failure diagnosis codes
• heart failure subtype coding
• echocardiogram results
• ejection fraction values
• left ventricular dysfunction coding
• patient review coding
  

System Triggers

This is an alert protocol which flags relevant patients when the patient record is opened or reviewed.

Change management considerations

Practices should ensure clinical teams understand:

• why heart failure subtype coding matters
• how HFrEF coding supports identification for treatment optimisation
• that non-HFrEF heart failure coding during the current QOF year suppresses the alert
• how to record patient review where further coding or management action is not required
• that coding should only be updated where clinically appropriate