8 March 2013

NICE to Review QOF Indicators for Cardiovascular Disease

The Department of Health has asked NICE to review indicators on cardiovascular disease for the Quality Outcomes Framework (QOF), to help improve outcomes for patients with the disease.

Research published in the Lancet shows that over the last decade, much progress has been made in the treatment and prevention of CVD, with a 40 per cent reduction in the rates of mortality among people under 75, and a narrowing in mortality rates between most and least deprived areas.

However, the research also shows that over the past 20 years, mortality rates for CVD have been declining much more slowly in the UK in comparison with the US and other European countries.

In order to help improve health outcomes for patients with the CVD, the Department of Health has launched a new strategy featuring 10 key actions.

Among these is for NICE to review the current indicators for CVD in the QOF - which rewards GP practices for the care they provide to patients - in order to ensure that the best treatments are offered in primary care.

NICE manages the process for developing QOF indicators, which are used to score points for practices according to their level of achievement.

The new strategy says that while the current QOF indicators provide incentives for best practice treatment, people diagnosed with CVD are not always optimally managed in primary care.

For example, those with atrial fibrillation are not always managed with anti-coagulants, people with diabetes are not always receiving the nine key process of care, and people with hypertension are not always adequately managed, increasing their risk of CVD.

The strategy also calls for more to be done to improve the identification of families at very high risk of CVD, including inherited conditions such as Familial Hypercholesterolemia.

This inherited condition, present from birth, leads to raised concentrations of cholesterol in the blood, and can lead to the early development of atherosclerosis and coronary heart disease.

The DH says that the uptake of cascade testing as recommended by the guideline has so far been ‘disappointing', with currently only 15 per cent of the estimated 100,000 cases of FH in England having been diagnosed.

It adds that 50 lives per year in England could be saved if the NICE recommendations on cascade screening were implemented.

Other actions in the strategy include helping to improve acute care for CVD by ensuring patients have access to the right treatments, based on evidence provided by NICE guidelines and quality standards.

The strategy says that if improvements were made in responding faster to acute events such as heart attack and stroke, and NICE guidelines and quality standards were followed in providing treatment, lives could be saved and quality of life could be improved.

It adds that commissioners should understand that the implications of commissioning services that do not meet NICE guidelines very often result in poorer care and poor value for money.

However, investment in services that prevent complications, such as specialist diabetes teams, can often result in improved quality of experience for the patient, and savings

Health Secretary Jeremy Hunt, said: "Today's proposals for those with cardiovascular diseases will bring better care, longer and healthier lives and better patient experience - which we must all strive to deliver."

Peter Hollins, Chief Executive of the British Heart Foundation, added: "We welcome the Outcomes Strategy.

"It has all the ingredients to tackle the threat posed by cardiovascular diseases which, despite the progress made in recent years, remain the major public health challenge of our time."