Hippo Labs uses the official NHS England QOF Business Rules v50.0 to help practices manage patients with heart failure (HF) — from accurate diagnosis and register validation to optimal treatment and annual reviews.
💬 Just a reminder: these indicators aren’t clinical guidelines — they define which patients appear for recall, how achievement is calculated, and where gaps may occur.
📋 The Heart Failure Registers
There are two registers that underpin heart failure indicators — one for all HF patients and another specifically for those with left ventricular systolic dysfunction (LVSD) or reduced ejection fraction.
❤️ HF001 — Heart Failure Register
Includes all patients with an unresolved diagnosis of heart failure.
✅ In short: all patients with a current, coded heart failure diagnosis should appear on the register.
💓 HF2_REG — Heart Failure (LVSD/Reduced Ejection Fraction)
Includes patients with heart failure due to LVSD or reduced ejection fraction.
✅ In short: this subset focuses on patients with heart failure caused by LVSD or reduced ejection fraction.
🩺 The Indicators
These indicators apply only to patients on one of the heart failure registers.
They measure diagnostic confirmation, treatment with ACE inhibitors, ARBs, and beta-blockers, and completion of an annual review.
🩻 HF008 — Confirmed Diagnosis
Measures:
% of patients diagnosed with heart failure on or after 1 April 2023 whose diagnosis was confirmed by echocardiogram or specialist assessment:
Within 6 months before diagnosis, or
Within 6 months after registration (if diagnosis made before joining the practice).
Counts as complete if:
Echocardiogram or specialist assessment recorded within the correct window.
Exclusions (PCAs):
Echocardiogram or HF care deemed unsuitable.
Palliative care patients.
Newly diagnosed or registered within 3 months.
⚠️ Common pitfalls:
Echocardiogram recorded after diagnosis but outside the 6-month window.
No diagnostic confirmation for patients transferring from another practice.
Using “service unavailable” codes without documenting an alternative assessment.
✅ In short: all new HF diagnoses since April 2023 should have a confirmed echo or specialist assessment within the correct timeframe.
💊 HF003 — ACE Inhibitor or ARB Therapy
Measures:
% of patients with LVSD/reduced ejection fraction who are treated with an ACE inhibitor or angiotensin II receptor blocker (ARB).
Counts as complete if:
Prescription for ACE-I or ARB in last 6 months.
Exclusions (PCAs):
Contraindication or decline for both ACE-I and ARB.
HF care unsuitable.
Palliative care.
Two care invites ≥7 days apart with no attendance (removed for payment only).
Newly diagnosed/registered within 3 months.
⚠️ Common pitfalls:
Missing decline/contraindication codes (leaving the patient appearing untreated).
Prescriptions older than 6 months.
Recording ARB intolerance but not prescribing ACE-I (and vice versa).
✅ In short: every LVSD/reduced-EF patient should be on an ACE-I or ARB, or have a valid exclusion coded.
💊 HF006 — Beta-Blocker Therapy
Measures:
% of patients with LVSD/reduced ejection fraction who are prescribed a licensed beta-blocker for heart failure.
Counts as complete if:
Licensed beta-blocker prescribed in the last 6 months.
Exclusions (PCAs):
Contraindicated, declined, or unsuitable for beta-blockers.
HF care unsuitable.
Palliative care.
Two invites ≥7 days apart with no attendance (removed for payment only).
Newly diagnosed/registered within 3 months.
⚠️ Common pitfalls:
Using unlicensed beta-blockers (e.g. atenolol, propranolol).
Missing contraindication or decline codes.
Recording the prescription outside the 6-month window.
✅ In short: every LVSD/reduced-EF patient should be on a licensed beta-blocker or have a valid contraindication or decline coded.
🩺 HF007 — Annual Review
Measures:
% of heart failure patients who have had a review in the last 12 months, including:
An assessment of functional capacity, and
A review of medication (medication review or HF-specific med review).
Counts as complete if:
Both a HF review and a medication review are coded within the last 12 months.
Exclusions (PCAs):
Declined or unsuitable for HF care.
Declined medication review.
Two invites ≥7 days apart with no attendance (removed for payment only).
Newly diagnosed/registered within 3 months.
⚠️ Common pitfalls:
Recording a medication review without the HF review code (both required).
Free-text entries instead of SNOMED codes.
Recording elements on different dates without a formal link.
✅ In short: every HF patient should have a combined HF and medication review recorded within the last 12 months.
🧩 Putting It All Together
Indicator | Focus | Who It Applies To | What It Measures | What to Do |
HF001 | Register | All HF patients | Accurate inclusion for recall | Ensure all HF diagnoses are coded as unresolved |
HF008 | Diagnostic confirmation | New diagnoses (after 1 Apr 2023) | Confirmation by echocardiogram/specialist | Record echo or specialist assessment within 6 months |
HF003 | ACE-I/ARB therapy | HF with LVSD/reduced EF | Evidence-based medication use | Prescribe ACE-I or ARB (or record contraindication/decline) |
HF006 | Beta-blocker therapy | HF with LVSD/reduced EF | Use of licensed beta-blocker | Prescribe or record contraindication/decline |
HF007 | Annual review | All HF patients | Functional capacity + medication review | Record HF review + medication review within 12 months |
🌟 Why This Matters
Following these indicators helps practices:
Maintain accurate heart failure registers.
Ensure all new diagnoses are clinically confirmed.
Support optimal prescribing for LVSD/reduced-EF patients.
Deliver consistent annual reviews with medication optimisation.
✅ In short: the Heart Failure Indicators ensure accurate diagnosis, safe treatment, and structured ongoing care for all patients with heart failure.
📚 Sources
NHS England QOF Business Rules v50.0 (Heart Failure, April 2025)
Primary Care Domain Reference Sets (TRUD Portal)