TABLE 8.

Summary of critical performance objectives that may be used to guide the development of performance indicators in all phases of the heart failure (HF) life cycle

Discharge/transitional care phase

Assessment of cognition in hospitalized older patients before discharge

Assessment of frailty in hospitalized older patients in view of identifying those requiring development of a multidisciplinary care plan

Provision of HF education initiation before discharge, and continuing after discharge, with a focus on the following: Home visits Medication reconciliation Self-management skills Health system navigation

Provision of a written discharge summary to the primary care physician within 48 h of discharge including the following: Plan of care and follow-up Inclusion of relevant care settings (HF clinic, other clinics, specialist, primary care)

Outpatient phase

Percentage of eligible patients receiving implantable cardiac defibrillators

Percentage of eligible patients receiving biventricular pacing (CRT)

Percentage of eligible patients receiving beta-blocker therapy

Percentage of eligible patients receiving ACE/ARB therapy

Percentage of eligible patients receiving spironolactone

Percentage of newly diagnosed HF patients who see an HF specialist within 6 weeks

Referral of higher risk HF patients to disease management programs including those with the following: Multiple comorbidities Multiple recent hospitalizations

Percentage of HF patients admitted to an outpatient clinic within recommended benchmarks: <24 h if NYHA IV or progressive HF <4 weeks if NYHA III <6 weeks if NYHA II

Medication review to identify potential drug interactions

Ensure appropriate immunizations (influenza, pneumococcal)

Percentage of HF patients referred to cardiac rehabilitation

Ensure appropriate communication between referring physician and HF clinic/specialist including the following: Results of pertinent investigations Pertinent medical history and consultant notes Recommendations regarding clinical and laboratory monitoring Recommendations regarding medication dose titration

Acute HF

Time to diagnosis of HF in acute decompensated setting

Accuracy of provisional HF diagnosis compared with final discharge diagnosis

Time to initiation of appropriate therapy specific to HF: Diuretics Nitrates as appropriate

Time of transfer to tertiary care centre for eligible patients with persistent cardiogenic shock

End-of-life planning and care – indicators

Percentage of HF patients who have a documented advanced care directive

Percentage of HF patients who have a proxy decision maker identified

Percentage of HF patients who have a documented discussion on resuscitation preferences

Number of reviews and revisions to a patient’s advanced care directive

Measures of quality end-of-life planning and care Patient- and family-centred decision making Communication about disease course and care plan Continuity of care Emotional and practical support Symptom management and comfort care Spiritual support Caregiver well-being

Percentage of HF patients who die in their place of preference

ACE Angiotensin-converting enzyme; ARB Angiotensin receptor blocker; CRT Cardiac resynchronization therapy; NYHA New York Heart Association functional classification