Welcome to the July issue of the National Heart
Failure Audit Newsletter. I hope you’re all enjoying the beautiful weather!
The purpose of this newsletter is to provide regular communication to keep local users of the audit up-to-date with audit developments and events.
Please get in touch is there’s anything you would like to be included in the next newsletter.
Contact details are on page 4.
Issue 6, July 2013
Thanks to everyone who has completed and submitted the survey of hospital facilities.
Out of 217 hospitals, there are 21 remaining who have not yet completed the survey. If yours is one of these remaining few, it would be fantastic if you could submit the survey as soon as possible, so we can start to look at the data.
If you sent a copy of the completed pro forma as a Word document – as opposed to filling in the form on Lotus Notes – please log in to validate the completed form, and contact Polly to confirm that all of the information therein is correct.
All hospitals which have either not yet submitted their survey or need to validate it have been emailed separately.
The National Heart Failure Audit 2012/13 Annual
Report will be published in October 2013.
As in 2011/12, the report will include hospital-level analysis. This will include the same analyses that were published last year, as well as some additional columns covering the new fields that were added to the dataset at the beginning of the year.
Prior to the publication of the report, each hospital will receive a copy of the hospital-level analysis that will be published in the report, compared to the national average. English hospital-level
Page 1 analysis will also be published on data.gov.uk, the
Government’s transparency website, once again.
This year we will be linking audit data to HES admission data as well as ONS mortality data, including cause of death. These additional linkages will allow us to produce a series of more detailed analyses of outcomes, including comparisons of cardiovascular and all-cause mortality, and combined endpoints, for example 30 day mortality or readmission.
Following the publication of the report, we intend to produce a patient friendly version
Issue 6

National Heart Failure Audit Newsletter
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Information about data definitions is provided below, particularly where multiple people have been in touch with queries.
If there are any data items about which you would like clarification, please contact Polly Mitchell. If a query about a particular data item is recurring, a clarification will be included in the next newsletter, and the application notes will be updated at the next opportunity to include the additional information.
Field 9.23 Echo
This field covers whether the patient has had an echo on this or a previous admission, and if so, the results thereof. Echo results within 6 months of the admission should be included, but tests carried out prior to this should not.
If the patient has not had an echo, but has had an MRI, a nuclear scan or an angiogram, the results of this test can also be included in the echo field.
Field 2.04a Received input from MDT
Note that this refers to the heart failure MDT only, and not any MDT.
Field 15.12 Review appointment with MDT/15.13 Date of review appointment
Similarly, the review appointment should only be recorded here if it is with the specialist heart failure
MDT.
Transfers
When a patient is transferred between two hospitals in a Trust, as part of the same admission, the audit record should be entered under the code of the hospital from which the patient was discharged.
Development of a web-based version of the National
Heart Failure Audit application is now under way, and we hope for it to be completed and beta tested by November.
The web-based application will have the same functionality as the Lotus Notes version of the audit, and data entered in each version will be visible and editable in the other. Import and export functions, as well as online reporting and data completeness views will remain in the web version.
There are two main advantages of a web based system—firstly, it does away with the need for licences, so more people in your Trust can access the audit, without needing to pay for additional licences. Secondly, because a web-based application is not dependent on Lotus Notes software, you will be able to access the audit, using your user ID and password, from anywhere in the hospital with internet access.
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National Heart Failure Audit Newsletter
In April 2014 we are planning on implementing a revision of the dataset. This will not be to the same scale as the April 2012 revision, but is intended to rationalise and slim down the core dataset. We have decided to follow the MINAP practice of smaller dataset revisions every two years, rather than larger, ad hoc revisions.
In 2012, a series of new fields were added to enable risk adjustment of the data. An initial attempt to develop a risk model later this year should tell us which of these additional fields in fact have a statistically significant risk associated with them. Those variables that are not significant can be removed from the dataset. The revision will also be an opportunity to review the non-core dataset.
We will be discussing and finalising the dataset revision in October and November. If you have any comments or suggestions, please get in touch by the end of September to ensure that they are taken into consideration.
The National Heart Failure Audit currently requires you to retrospectively audit patients using medical notes taken during their admission. The process of acquiring and interpreting the notes can be a long and difficult one and we are aware that it does not encourage or facilitate high participation rates and good data quality.
Therefore, discussions have begun as to the best way of changing the audit methodology, such that patients are identified prospectively – this would mean that patients could be identified for inclusion, and data entry could begin, whilst they are still in hospital. The audit would still cover patients admitted to hospital with acute heart failure, but they would be identified in a different manner.
The exact details of the new methodology are yet to be determined, but it has been suggested that identifying patients based on a combination of their admission code and test results (echo and
BNP measurement) would ensure that patients included in the audit have validated heart failure,
Page 3
We are pleased to announce that we have recruited two new Heart Failure Nurse Specialist representatives to the audit Project Board—Kathy
Simmonds, from Kettering General Hospital NHS
Foundation Trust, and Dawn Lambert from
Portsmouth Hospitals NHS Trust.
Thank you to everyone who applied and came down to London to be interviewed for the position.
The candidates were all of a very high calibre, and it was a tough decision to choose the final two.
Kathy and Dawn will attend quarterly Project
Board meetings and will be involved in decisions about audit development and strategy. They both have extensive experience collecting and inputting data to the audit, so we hope they will be especially useful in helping to improve the audit methodology and advising on how to make the audit application easier to use.
with wrongly coded heart failure filtered out.
The change in methodology would occur following the development of a web-based system as this will enable audit data to be entered anywhere in the hospital – not just on particular computers which have Lotus Notes installed.
If you have any comments about the development of a new audit methodology, please do let us know. Discussions are still at an early stage, and we are still very much open to suggestions.
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National Heart Failure Audit Newsletter
Please continue to keep us updated of any changes to the contact details of those people involved with the audit, so that we can keep you informed of changes to the database and important updates relating to the audit .
If someone with access to the National Heart
Failure Audit database leaves the Trust, goes on maternity leave or is no longer responsible for the audit, the name on the Lotus Notes licence and ID file will need to be changed.
Please contact Polly Mitchell and the NICOR helpdesk in the instance of any changes to database users or contact details.
General enquiries
Contact Polly Mitchell with any clinical queries, general questions about the audit, or regarding any of the articles in this newsletter.
Email: polly.mitchell@ucl.ac.uk
Tel: 0203 108 3927
Technical enquiries
For any technical questions, or problems using Lotus Notes or importing data, please contact the NICOR helpdesk.
Email: nicor-helpdesk@ucl.ac.uk
Tel: 0203 108 1978
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