Maintaining quality

Quality in the provision of cardiology services is monitored in a number of ways. Quality markers may be used for nationally published audits, to establish commissioning contracts and linked to payment within commissioning agreements.

Many aspects of cardiology care are included within the quality and outcomes frameworks produced by NHS England in consultation with NICE and other stakeholders. The General Medical Services QOF for primary care guidance for 2015/16 is available. The NHS Outcomes Framework 2015 to 2016 includes an at-a-glance table.

Within the UK, an extensive programme of mandatory data collection and audit has been developed to inform and improve practice.  Key areas of cardiology practice are the subject of national mandatory Health and Quality Improvement Partnership (HQIP) audits which report annually and require continuous data collection from NHS providers on:

•    coronary intervention

•    cardiac implantable electronic device implantation

•    cardiac electrophysiology procedures

•    heart failure management

•    cardiac prevention and rehabilitation.

A programme of audit and outcome standards partly informed by these datasets is also used to evaluate the quality of care for cardiac patients. The National Institute for Cardiovascular Outcomes Research undertakes audits in partnership with professional societies. Data are available for unit and individual outcomes for surgical and interventional procedures. The NICE guidelines listed below include quality standards for common cardiac diseases, eg chronic heart failure. Further examples are contained in Table 1 below. These apply to primary, secondary and tertiary care services. National Commissioning for Quality and Innovation (CQUINs) payments frameworks and local commissioning agreements typically include key performance indicators based on these standards.

Table 1: Cardiology services and quality standards

Type of care/setting

Service

Associated NICE or professional guidelines

Quality markers

 Primary care

  1. Screening for cardiovascular disease risk
  2. Management of hypertension
  3. Triage of patients with cardiac symptoms
  4. Shared chronic disease management

Primary Prevention

JBS3

Hypertension

Chest pain of recent onset

Diagnosis of heart failure

QOF

Secondary care outpatients

  1. Rapid access chest pain clinics
  2. General cardiology clinics
  3. Specialist clinics eg for heart failure, atrial fibrillation, valvular heart disease

Chest pain of recent onset

 

 

Secondary care emergency and in-patient care

  1. (Suspected) acute coronary syndromes
  2. Disabling arrhythmias
  3. Severe breathlessness

STEMI / NSTEMI guidance

Atrial fibrillation

Heart failure

MINAP

Tertiary and quaternary care

  1. Management of coronary artery disease
  2. Complex arrhythmia management
  3. Severe/end stage heart failure
  4. Severe valve disease potentially requiring interventional / surgical therapy
  5. Infective endocarditis

NICE guidance on prophylaxis of IE

ESC guideline on IE

BCIS audit

Non-invasive cardiac investigations and cardiac imaging

  1. ECG
  2. Echocardiography (including stress and TOE)
  3. Ambulatory cardiac monitoring
  4. Ambulatory blood pressure monitoring
  5. Treadmill exercise stress testing
  6. Tilt table testing
  7. Myocardial perfusion scintigraphy
  8. CT cardiac and coronary imaging
  9. Cardiac magnetic resonance imaging

10. PET (PET CT) cardiac imaging

Procedure guidelines for radionuclide myocardial perfusion imaging

 

CTCA standards

CT coronary angiography service specification 

 

 

 

BSE Individual and Departmental Accreditation

 

BSCMR BSCI standards document

 

Invasive and interventional cardiology

(simpler procedures can be undertaken in secondary care, others mainly in tertiary or quaternary cardiac centres)

  1. Invasive coronary angiography
  2. Percutaneous coronary intervention including primary PCI for myocardial infarction
  3. Pacemakers for bradyarrhythmias and CRT devices for heart failure
  4. ICDs for ventricular arrhythmias and prevention of sudden cardiac death
  5. Electrophysiology studies and ablation therapies for tachyarrhythmias
  6. Implantation of loop recorders for unexplained syncope
  7. Percutaneous interventions for valvular heart disease including TAVI

 

NICE guidance

BHRS national audits

Cardiac disease prevention and rehabilitation

Multidisciplinary programmes for all patients post cardiac surgery, myocardial infarction, angina and heart failure and post-ICD implantation

BACPR

BACPR audit

Services for heart failure

Multidisciplinary coordinated services across health care boundaries

NICE guidance:

Chronic heart failure in adults: management

Acute heart failure: diagnosis and management

 

Chronic heart failure overview

 

BSHF heart failure audit

 

Inherited cardiac disease

Specialist assessment services with imaging and genetic support plus specialist nursing

 

 

Hypertension

Supporting primary care for complex cases linking closely to cardiovascular risk management

British Hypertension Society

 

Hypertension in adults: diagnosis and management

 

 

Adult congenital heart disease

Hub and spoke integrated care models

 

 

Cardiac physiology departments

Based in secondary/tertiary care or in community settings. NHS and non-NHS providers. Undertake non-invasive cardiac investigation

 

IQIPS

BSE lab accreditation