Development of an evidence-based scoring system (HF-IS) to assess the quality of heart failure programmes for patients postdischarge from hospital

Aim. The aim of this study was to develop a potential scoring algorithm for interventions in a chronic heart failure management programme - the Heart Failure Intervention Score - to facilitate quality improvement and programme auditing. Background. The overall efficacy of chronic heart failure management programmes has been demonstrated in several meta-analyses. However, meta-analyses did not determine individual interventions in a programme that resulted in beneficial patient outcomes. Design. A prospective cross-sectional survey design. Method. All chronic heart failure management programmes in Australia (n=62), identified by a national register, were surveyed to determine programme characteristics and interventions. Results. Of the 62 national chronic heart failure management programmes, 48 (77%) completed the survey and 27 individual interventions were identified. Variability in the use of the key interventions was common among the programmes. Each intervention was given an arbitrary weighted score according to the level of supportive evidence available and a total score calculated. Programmes were then categorised into low or high complexity based on several interventions implemented and their weighted score. A total score of ≥190 (median=178, interquartile range 176-195) was used to divide programmes into two groups. Nine programmes were categorised into high Heart Failure Intervention Score group and majority of these were based in the acute hospital setting (78%). In the low Heart Failure Intervention Score group, there were 39 programmes of which there were a higher proportion of community-based programmes (38%) and programmes in small community hospitals (10%). Conclusion. The Heart Failure Intervention Score provides a potential evidence-based quality improvement tool through which a set of minimum standards can be developed. Implementation of the Heart Failure Intervention Score provides guidance to programme coordinators to enable monitoring of standards of heart failure programmes, which may potentially result in better patient outcomes. Relevance to clinical practice. The Heart Failure Intervention Score is an evidence-based tool that can be easily used by heart failure programme coordinators to ensure that their programme is evidence-based, which will improve the quality of their programme and potentially programme outcomes.