Guideline-recommended therapies for heart failure (HF), particularly for HF with reduced ejection fraction, reduce morbidity and mortality.1 Yet observational data show geographic variation in their application in clinical practice.2–6 This disconnect between the development and the implementation of new healthcare technologies, the so-called ‘second translational gap’,7 calls for new initiatives which may identify areas for quality improvement in HF care.
Quality indicators (QIs) are increasingly used as means to measure the adherence to, and the outcomes associated with, guideline-recommended therapy.3 Given that they relate to discrete aspects of care, they allow more informed interpretation of ‘real-world’ data.8 A number of organizations including the American College of Cardiology (ACC)/American Heart Association (AHA) and the National Institute for Health and Care Excellence (NICE) recognized this and have developed an array of measures of care quality for HF.9–15 However, there is a need for QIs that are sufficiently detailed such that they are relevant to specialist and contemporary HF care, and designed to be applicable to European healthcare systems.