The audit criteria listed in the following pages reflect the key recommendations of the NICE clinical guideline on the management of chronic heart failure in adults in primary and secondary care. Whilst one of the criteria (pre-discharge management plan) relates to hospital care, and one (disease register) relates mainly to primary care, the remainder should be applied to both primary and secondary care settings. It is anticipated that the standards will be detailed in local development plans.

Year-on-year improvement in the results of the audit criteria is important, and comparison with other local health care communities may be helpful in setting realistic milestones towards the target standard. The ‘exception’ boxes list the circumstances where applying the standard would be inappropriate for an individual patient. It is recognised that there will be other situations where a clinical decision may be taken not to follow the guideline (for example taking into account the informed patient’s wishes), and interpretation of performance should take these factors into account.

Heart failure registers are a necessary pre-requisite to performing these audits. They are needed to establish the denominator, and to facilitate accurate data collection. The criteria are all process criteria. It is also recommended that consideration should be given to setting up audit of re-admission rates for heart failure within 30 days of discharge. It is difficult to set a ‘standard’ for such an outcome measure, since it would be unrealistic to expect a routine audit to be able to differentiate between ‘avoidable’ and ‘unavoidable’ admissions.

A potential problem with the criteria proposed is that general practices that have low identification rates of heart failure (perhaps because of poor coding, or under-investigation) may apparently perform very well against these criteria. Therefore, we would propose that an additional data item that should be reported in general practice is age-specific prevalence of heart failure. This would allow the standards achieved to be interpreted against the practicespecific prevalence.