Advancing Quality NHS Advancing Quality Alliance

Heart Failure

Heart failure is the result of the heart’s inability to pump enough to maintain blood flow to rest of the body, it is often caused by heart attacks, high blood pressure and heart disease. Symptoms commonly include shortness of breath, excessive tiredness, and leg swelling

There are two main types of heart failure: heart failure due to left ventricular dysfunction and heart failure with normal ejection fraction.


when the part of the heart that pumps blood around your body (the left ventricle) becomes weak

NHS Choices


usually a result of the left ventricle become stiff, causing difficulty filling with blood

NHS Choices

Through research, clinical input and clinical guidelines Advancing Quality has developed six measures that, when applied at the appropriate time, can greatly increase the outcomes for patients. Advancing Quality uses these measures to monitor the quality of care given to patients across the North West with the aim of improving standards and reducing variation in care.


1. Specialist review within 72 hours of documentation (Introduced Oct 2015)

Patients benefit from the specialist knowledge and skills of heart failure specialists, particularly at the point of diagnosis. Specialist directed care is associated with more efficient symptom control, and prompt, definitive intervention reduces the chance of deterioration and adverse outcome. Readmission rate and inpatient mortality are reduced if an inpatient spell is managed by specialists.

2. Referral for appropriate heart failure follow up

When you are discharged from hospital you should receive a referral to a follow-up clinic. Depending on the time you spend in hospital and the treatment and investigations you undergo during your stay will depend on the type of follow-up you require.

3. Assessment of heart pumping blood

These checks enable doctors to tailor treatment for each patient. This can be done while you are in hospital or when you get home.

4. Medication to lower blood pressure

If doctors believe the 'pumping' part of the left side of your heart is not working properly they will prescribe you specific medications that widen the blood vessels and lower blood pressure.


ACEi :  A medicine that relaxes blood vessel walls and lowers blood pressure.
ARB : A medicine group assists in the widening of  blood vessels and and reduces hypertension

5. Healthy lifestyle instructions when you leave hospital

It is important you have these lifestyle instructions as they will help you to do safe activities, make changes to your diet and manage your medication. The instructions will also tell you how to contact your nurse or doctor is you are worried about your condition.

6. Help to stop smoking (Retired Oct 2015)

If you are a smoker you will be offered support and advice to stop smoking. Stopping smoking reduces the chance of further health problems. In October 2015 clinical experts in the North West decided that progress in smoking cessation and the number of patients that have quit smoking meant the measure was only applicable to a small minority, therefore the measure was retired.

7. Medication to slow the heart rate given when you leave hospital (Introduced Y6)

Beta blockers help reduce the heart rate. A slower heart rate means the heart has to do less work as it needs less blood, oxygen and nutrients.


Beta blockers are medicines that affect the body's response to certain nerve impulses. This, in turn, decreases the force and rate of the heart's contractions, which lowers blood pressure and reduces the heart's demand for oxygen.

8. Specialist review when in hospital (Introduced Y6 | Retired Oct 2015)

Patients benefit from specialist knowledge and skills which can prevent deterioration, assist in self management and increase the quality of life. In Oct 2015 clinical experts in the North West decided that this measure should retire. In its place a similar measure, refined to reflect the importance of timely review by a specialist was introduced.
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