Quality Standards
Issued: June 2011

Chronic heart failure quality standard

Introduction and overview

This quality standard covers the assessment, diagnosis and management of chronic heart failure in adults.


Heart failure is a complex clinical syndrome in which the heart's ability to pump blood around the body is reduced. It is caused by structural or functional abnormalities of the heart. The most common cause of heart failure in the UK is coronary heart disease, and many patients have had a myocardial infarction in the past.

Patients with chronic heart failure often experience a poor quality of life; symptoms include breathlessness, fatigue and ankle swelling and over one third of patients experience severe and prolonged depressive illness. Heart failure has a poor prognosis: 30–40% of patients diagnosed with heart failure die within 1 year; thereafter the mortality is less than 10% per year. Heart failure accounts for 2% of all NHS inpatient bed-days and 5% of all emergency medical admissions to hospital. Readmissions are common: about 1 in 4 patients are readmitted within 3 months.

Effective multidisciplinary specialist services for people with chronic heart failure can have a positive effect on patients' life expectancy and quality of life and evidence suggests they can help to reduce recurrent hospital stays by 30–50%.

This quality standard describes markers of high-quality, cost-effective care that, when delivered collectively, should contribute to improving the effectiveness, safety and experience of care for people with chronic heart failure in the following ways:

  • Preventing people from dying prematurely.

  • Enhancing quality of life for people with long-term conditions.

  • Helping people to recover from episodes of ill health or following injury.

  • Ensuring that people have a positive experience of care.

  • Treating and caring for people in a safe environment and protecting them from avoidable harm.

The NHS Outcomes Framework 2011/12 is available from www.gov.uk.


The quality standard for chronic heart failure requires that services should be commissioned from and coordinated across all relevant agencies encompassing the whole chronic heart failure care pathway. An integrated approach to provision of services is fundamental to the delivery of high-quality care to adults with chronic heart failure.