AST011

These patients need a spirometry and another objective test (peak flow or FeNO) and this applies to all patients aged 6 and over. If you do not have an appropriate local spirometry service you can code as ‘QOF diagnostic spirometry service not available’ and the patient will be removed from the parent population. Please be aware that if you don’t have any spirometry services and all patients are coded in this way you will not get any of the 15 points as you need at least one included patient to get the points.

If the patient has to be referred for a spirometry you can code as ‘referral for spirometry reversibility test’ and this counts as a spirometry done so these patients will be included as long as they also have a peak flow or FeNO test recorded.

You can also code patients as unsuitable for spirometry if that’s appropriate.

The full list of codes for this are in our support article. 

This indicator is changing in the new QOF year, more details can be found in our 2025/26 support articles or you can catch up with our webinar recording on all the QOF changes here.

AF008

This indicator expects patients on the AF register with a CHA2DS2-VASc score of 2 or more to be on a DOAC as first line, or a Vitamin K antagonist if there is a good reason for them not to be on warfarin. 

If they are on warfarin instead of a DOAC one of the following actions are needed:

1.  Code the reason they are not on a DOAC – note that this is an expiring code and needs to be added each year.

2.  If the patient has a mechanical heart valve, code this to permanently include them whilst on warfarin. 

3.  Warfarin needs to have been issued in the last 6 months of the QOF year, meaning it needs to be issued anytime after 1^st October (this includes recording it as a hospital issue if the warfarin is issued and monitored by a third party).       

4. TTR (time in therapeutic range) – this is the one people often struggle with as the information needs to be requested from whoever issues the warfarin. If you have coded DOAC not indicated, there needs to be a TTR value. Users have reported issues with information not being recognised by the QOF searches. If you use a system such as INRstar you may need to check that the information has been imported into EMIS in the correct format as it can be saved as free text information instead of a value.

Our support article covers the different options that may apply for a patient and the codes that are appropriate. Don’t forget that anything referred to as an ‘expiring’ code will need to be added each QOF year but ‘persisting’ codes only need to be added once. 

Finally, if a patient no longer has AF it may be appropriate to code as ‘Atrial fibrillation resolved’. This removes them from the AF register.

HF008

This indicator requires an echo OR specialist assessment in the 6 months BEFORE the first time HF is coded. Or if they are a new patient who didn’t have this done in their previous practice they will need an echo or specialist assessment within 6 months of the date of registration.

This one can cause a lot of headaches, especially when the patient is diagnosed in hospital and the discharge summary doesn’t have the information you need.

The key thing to remember is that referring someone for an echo or to cardiology counts. So if they were diagnosed during an emergency admission and there’s a note that they are going to be followed up by cardiology or have a confirmatory echo you could code ‘referral to cardiology service’ or ‘referral for echocardiography’ as appropriate. The full list of codes that work for this are in our support article.

It may also be worth coding as suspected heart failure until the diagnosis has been confirmed, depending on what is most appropriate for the patient.

We have support articles for all the different QOF indicators so if you’re struggling with anything else in these last few days of the QOF year just have a look at the relevant article. You can find all of our QOF support articles here.