HF009 replaces the previous HF due to LVSD indicator and now includes patients with HF and reduced injection fraction recorded. Ejection fractions have been very inconsistently recorded in the past so your HF register is likely to need a lot of validating. All patients previously on the 2nd part of the HF register because they had LVSD coded will no longer be included if they do not have a reduced ejection fraction coded.
Examples –
Practice 1 – list size just over 11,000
- HF1 Register – 201
- HF2 LVSD Register (last year) – 189
- HF3 EF Register (this year) – 77
- Patients with LVSD and no EJ – 112 to be reviewed and appropriately coded
Practice 2 – list size 15,200
Reviewed HF/LVSD patients with no echo/EJ ≤ 40
Register has reduced from 150 to 80 following a review for each patient, was a pretty laborious exercise but essential for data quality and it identified some interesting coding issues:
- EF is above 40 but the Cardiologist has commented the LV function is “reduced” and “mildly reduced” so lots of coding to be validated also
- HF data entry template needed editing to make it easier for the coding team to code more accurately going forward
Another common question we are being asked is:
Patient had EF ≤ 40 recorded but it has now improved to 51%, how do we remove them from the register?
HF resolved is the only code to remove a patient, the indicator looks for EF ≤ 40 ever (not latest) so if their EF improves, they will remain on the register and require treatment. So ensure you code all EF results as an improved EF will not overwrite the original reduced EF and remove the patient from the register.
Once you have your register validated, these patients then need to be treated with 4-pillars of therapy – SGL2, ACE or ARB, betablocker & MRA – all 4 therapies need to be listed (or an appropriate PCA for each area) in order to achieve the indicator.
