Heart failure (HF) - QOF indicator

Heart failure QOF indicators cover confirmation of diagnosis, ongoing review and treatment for patients with reduced ejection fraction. For 2026/27, HF009 replaces HF003 and HF006, reflecting the September 2025 NICE update recommending four disease-modifying medicines for heart failure with reduced ejection fraction.

Heart failure indicators

Why heart failure is included

• Unlike other major cardiovascular diseases, heart failure has a rising prevalence, and its prognosis is poor. Unless an indicator specifies a narrower group, these measures apply to everyone with heart failure.

• Reviews of primary care records have found variation in how ejection fraction is documented as reduced, mildly reduced or preserved. Practices should record the applicable category for every patient: without it, treatment may vary unnecessarily or be insufficient or excessive, with potentially poorer outcomes.

HF008: confirming the diagnosis

HF008 draws on NICE IND192.

Rationale

• The indicator promotes confirmation of heart failure diagnoses alongside investigation of their causes.

• Clinical symptoms and signs alone cannot establish heart failure. Investigations are needed both to demonstrate cardiac dysfunction and to determine its cause. For suspected chronic heart failure, NICE recommends using N-terminal pro B-type natriuretic peptide (NT-proBNP) results to guide onward referral. Raised levels require echocardiography and specialist assessment within 6 weeks; very high levels require these within 2 weeks. For newly suspected acute heart failure with raised natriuretic peptides, NICE recommends echocardiography within 48 hours of admission to hospital.

Reporting and verification

• The table sets out the qualifying requirements for HF008. For measurement, the period of three months before diagnosis is treated as 93 days.

HF007: ongoing review

HF007 draws on NICE IND195.

Rationale

• Reviewing patients regularly is linked to better quality of life and less need for urgent hospital admission. NICE guideline NG106 advises monitoring at short intervals (days to 2 weeks) following a change in clinical condition or medication, and 6-monthly monitoring when heart failure is stable.

• Significant comorbidity or deterioration since the last review calls for more detailed monitoring. Care should also be tailored to account for frailty and palliative and end of life needs.

Reporting and verification

• The requirements for HF007 are those given in its definition in the table.

HF009: treatment for reduced ejection fraction

HF009 draws on NICE IND317.

Rationale

• HF009 promotes optimal treatment for people with heart failure with reduced ejection fraction (HFrEF). The September 2025 update to NICE's chronic heart failure guideline (NG106) recommends offering four disease-modifying medicines: a sodium-glucose cotransporter-2 (SGLT2) inhibitor, a beta-blocker, a mineralocorticoid receptor antagonist (MRA), and either an angiotensin-converting enzyme inhibitor (ACE-I), an angiotensin II receptor blocker (ARB) or an angiotensin receptor-neprilysin inhibitor (ARNI). Together, these treatments form what is commonly termed the four-pillar approach to heart failure care.

• NICE considers this combination cost-effective and reports that it reduces cardiovascular-related deaths and hospital admissions.

• HF009 takes the place of the previous QOF indicators HF003 and HF006.

Reporting and verification

• Apply the qualifying criteria in the HF009 definition in the table.