Policy responses and statements
- Name of organisation:
- National Clinical Dataset Development Programme
- Name of policy document:
- Heart Failure Dataset - Consultation Document
- Deadline for response:
- 18 August 2006
Background: The National Advisory Committee for CHD (NACCHD) commissioned the development of a Heart Failure Dataset for NHS Scotland to ensure common information standards across all clinical settings in which people are undergoing treatment for Heart Failure. The Heart Failure Dataset Clinical Working Group was established in October 2005 to progress this work, supported by the National Clinical Dataset Development Programme (NCDDP) Support Team.
The Heart Failure Dataset will:
- Define common data items recommended for collection in a wide variety of clinical settings
- Support the exchange of patient information between healthcare providers
- Support the consistent recording of patient information throughout NHS Scotland
It is envisaged that the Heart Failure Dataset will be recorded within clinical systems. The dataset contains data items from Generic Data Standards, which have previously been developed through the NCDDP.
The NCDDP asked for feedback from the wider clinical community in order to ensure that these data standards are fit for purpose. All interested organisations and individuals were invited to take part in this consultation.
COMMENTS ON
NATIONAL CLINICAL DATASET DEVELOPMENT
PROGRAMME HEART FAILURE DATASET
The Royal College of Physicians of Edinburgh is pleased to respond to the National Clinical Dataset Development Programme on its consultation on the Heart Failure Dataset.
GENERAL COMMENT:
The College is extremely concerned that the proposed dataset is complex and unlikely to be completed consistently or accurately across all units, particularly in District General Hospitals where junior cardiologists and general physicians may find the specific observations and clinical measurements challenging. The dataset is beyond that often collected in clinical trials. A much simpler coding system may be more clinically useful. Having said this, the College offers the following specific comments on detail within the proposed dataset.
SPECIFIC COMMENTS:
Jugular Venous Distension - p14
Atrial not arterial.
It might be better to use “not visible” rather than “invisible”.
Cardiac Auscultation Record - p14
This may be superfluous. If there is a result (see following comment), it has been done – this adds no extra information.
Cardiac Auscultation Result - p15
Some of this unlikely to be recorded accurately. Heart sound volumes are difficult even for the experience physician, and often wrong.
Chest Auscultation - p16-17
Same comments as above
No breath sounds – patient dead will raise eyebrows. It is possible to have very quiet breath sounds which sound like no breath sounds eg in bad emphysema/AWO.
The correlation between the recorded abnormalities and the definitions used may well be poor.
Medication and Immunization
Reason for delay in IV therapy.
The implication that delay is inappropriate may encourage excessive use of IV therapy.
Personal History - p24
Cardiovascular conditions – distinguish types of cardiomyopathy. Implications of HCM are very different from DCM.
Personal History - p25
May be worth adding depression as it is very common and important in heart failure.
Symptom severity (Ischaemic Chest Pain) - p32
It may be worth defining or offering guidance about the definition of ischaemic pain.
Referral Receiver - p36
The list of receivers should include “General physician” and potentially psychiatry or clinical psychology.
BNP assay - p39
Likely to change frequently. May need to include which generation assay. Specifying the range for assay may also be helpful so that in house assays will be captured. Alternatively, normal/abnormal, so that result is assay independent.
ECG results - p43
Item 11, IV conduction defects. A-D seem to be mutually exclusive. You can have RBBB with LAHB or LPHB, better in different fields.
Need a date ECG recorded.
Echocardiography - p50
Date for echo needs recording. This is critical as things change.
Echocardiogram Results (LV) Regional Wall Motion score - p53
It would be incorrect to say the wall is ischaemic, only that it is not moving or hypokinetic. This term should not figure in the echo description (unless stress echo).
Echo results PAP - p57
Should clarify whether this is the recorded velocity jet of the tricuspid regurgitation or the estimated PA Pressure. Recording the jet velocity only is preferable as any estimate will be used variably – unless a definition is suggested. Recording directly observed data is preferable to derived data.
Coronary angiography Table - p60
Compare the detail of this with the detail of the physical examination. Extreme physical examination detail which is poorly reproducible and of limited prognostic value, whereas coronary angio data is fairly reproducible and prognostically important. If it is to be useful it needs much more detail ie severity of stenosis (critical). It would be possible to grade someone with severe LVSD from CAD the same as someone with a cardiomyopathy and concomitant mild CAD the same for the coronaries by the suggested method. The suggested way is inconsistent with the detail in other areas.
Left ventricular angiography - p60-61
It may be useful to include ejection fraction?
Exercise test - p63
Reason for stopping. Often not keeping up with the treadmill speed is the main reason!
Radiology Table - Myocardial perfusion imaging - p66
Definitions for Hibernation and Stunning needed (particularly stunning). Is it pseudodilatation or transient ischaemic dilatation?
Decompensation Reason - p73
It would be useful to find a way of recording when drug doses have been changed as this accounts for a significant number of admissions. This is separate from prescribed drugs causing problems and could be styled as “prescription altered?”.
Procedures - p75 et seq
PCI should be added - there is space for CabG in cardiac surgery but no space for PCI despite there being for valvuloplasty. Some revascularisation for CHF is done percutaneously – despite lack of evidence.
Copies of this response are available from:
Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.
Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939
[17 August 2006] |
