Relationships between emerging measures of heart failure processes of care and clinical outcomes (original) (raw)
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Quality of heart failure care in managed Medicare and Medicaid patients in North Carolina
The American Journal of Cardiology, 2004
and -adrenergic receptor blockers in patients with heart failure (HF) remains low despite the results of clinical trials and evidence-based guidelines that support their use. The quality of HF care in managed Medicare and Medicaid programs in North Carolina participating in a HF quality improvement program was assessed. Managed care plans identified adult patients with 1 inpatient or 3 outpatient claims for HF during 2000. A stratified random sample of 971 Medicare and 642 Medicaid patients' outpatient medical records from 5 plans were reviewed by trained nurse abstractors to obtain data regarding type of HF, demographics, comorbidities, and therapies. Left ventricular function as-sessment was performed in 88% of patients. Among 494 patients with systolic dysfunction, 86% were appropriately treated with respect to ACE inhibitors (73% prescribed, 13% had a documented contraindication). In contrast, -blocker therapy was appropriate in 61% (49% prescribed, 12% contraindication). There were no significant differences in drug use by insurance, gender, race, or age. Ventricular function assessment and ACE inhibitor prescription rates are higher than -blocker prescription rates among Medicare and Medicaid managed care patients in North Carolina. Opportunities for improvement remain, particularly for -blocker use. ᮊ2004
URING THE LAST DECADE, THE most prominent change in the acute care of patients with heart failure (HF) was a decreasing length of stay in hospitals. 1-6 Advances in the care of patients with HF, including drugs such as angiotensin-converting enzyme inhibitors, -blockers or aldosterone antagonists, and cardiac device-related therapies such as implantable defibrillators or resynchronization, accrue benefits to patients after months or years of therapy. No parallel progress in the acute drug or procedural treatment of patients with HF has occurred. The reduction in hospital length of stay could have reduced the risk of hospital-associated adverse events. Conversely, shortening the time in the hospital could have led to more adverse events in the period early after dis
2015
Background—Characteristics and outcomes of patients with heart failure and reduced ejection fraction receiving care at Veterans Affairs (VA) versus non-VA hospitals have not been previously reported. Methods and Results—In the randomized controlled Beta-blocker Evaluation of Survival Trial (BEST; 1995-1999), of the 2707 (bucindolol=1353; placebo=1354) patients with heart failure and left ventricular ejection fraction ⩽35%, 918 received care at VA hospitals, of which 98% (n=898) were male. Of the 1789 receiving care at non-VA hospitals, 68% (n=1216) were male. Our analyses were restricted to these 2114 male patients. VA patients were older with higher symptom and comorbidity burdens. There was no significant between-group difference in unadjusted primary end point of 2-year all-cause mortality (35% VA versus 32% non-VA; hazard ratio associated with VA hospitals, 1.09; 95% confidence interval, 0.94–1.26), which remained unchanged after adjustment for age and race (hazard ratio, 1.00; ...
Congestive Heart Failure, 2012
Whether provider education changes practice for HF has not been reported. (NHeFT)Ô uses didactic and experiential training of primary care providers (PCP) to optimize treatment of HF. We randomized PCP's in the Cleveland VA clinics to training (T) vs control (C). Endpoints: Primarythe number of patients with EF < 40% treated with ACEI ⁄ ARB and Beta Blocker, + ⁄ ) diuretic post T vs pre T; Secondary -the number of patients with increase in ACEI ⁄ ARB or a decrease in diuretic post T vs. pre T. Of 641 patients, 216 (85 C,131 T) had EF < 40%; 188 (85%) did not meet the primary endpoint at baseline. After T, a similar proportion (64.2% C, 74.4%,T) met the endpoint at end of study (P = 0.14). The odds of a patient meeting the primary endpoint by care of a T provider, was not significantly higher than C (OR 1.496, 95% CI (0.751, 2.982)). Patients seen by T were more likely to have the diuretic dose decreased vs patients under C, without increases in ACEI or ARB (P < 0.03). Thus, a didactic program of HF plus a preceptorship changed practice modestly. Studies should address provider readiness of change and self efficacy to adhere to evidenced-based care. Ó2012 Wiley Periodicals, Inc.
Arquivos brasileiros de cardiologia, 2016
Despite the availability of guidelines for treatment of heart failure (HF), only a few studies have assessed how hospitals adhere to the recommended therapies. Compare the rates of adherence to the prescription of angiotensin-converting enzyme inhibitor or angiotensin II receptor blockers (ACEI/ARB) at hospital discharge, which is considered a quality indicator by the Joint Commission International, and to the prescription of beta-blockers at hospital discharge, which is recommended by national and international guidelines, in a hospital with a case management program to supervise the implementation of a clinical practice protocol (HCP) and another hospital that follows treatment guidelines (HCG). Prospective observational study that evaluated patients consecutively admitted to both hospitals due to decompensated HF between August 1st, 2006, and December 31st, 2008. We used as comparing parameters the prescription rates of beta-blockers and ACEI/ARB at hospital discharge and in-hosp...
BMJ Open
ObjectivesTo evaluate the effect of cardiologist care on adherence to evidence-based secondary prevention medications, mortality and readmission within 6 months of discharge in patients with heart failure (HF).DesignRetrospective observational study based on administrative data.SettingLocal Healthcare Authority (LHA) of Bologna, one of the largest LHAs of Italy with ~870 000 inhabitants.ParticipantsAll patients residing in the LHA of Bologna discharged from hospital with a diagnosis of HF between 1 January 2015 and 31 December 2015.Primary and secondary outcome measuresMultivariable regression analysis was used to assess the association of inpatient and outpatient cardiologist care with adherence to evidence-based medications, all-cause mortality and hospital readmission (including emergency room visits) within 6 months of discharge.ResultsThe study population included 2650 patients (mean age 82.3 years). 340 (12.8%) patients were discharged from cardiology wards, while 635 (24.0%) ...
Association between process quality measures for heart failure and mortality among US veterans
American heart journal, 2014
The few available studies of the Centers for Medicare and Medicaid Services Hospital Inpatient Quality Reporting (IQR) care process indicators have not linked receipt of recommended care processes in heart failure (HF) with lower mortality. Because the Veterans Health Administration (VHA) also tracks hospital inpatient quality reporting indicators, in addition to VHA-specific inpatient (pneumococcal and influenza vaccination) and outpatient (angiotensin-converting enzyme inhibitor [ACEI] or angiotensin receptor blocker [ARB] use for left ventricular [LV] dysfunction and LV function documentation) care process indicators, we examined the association between receipt of these care processes and 30-day and 1-year mortality. Retrospective study of 107,045 patients with HF treated at 128 VHA hospitals between 2001 and 2007 and followed up through 2008. We assessed the relationship between receipt of each HF care process and death at 30 days (inpatients only) and 1 year (all patients), usi...
Circulation, 2015
I nitiation and continuation of individual guideline-directed medical therapies before hospital discharge have been associated with improved adherence and clinical outcomes for patients with heart failure (HF). 1-3 Reflective of these data, current clinical practice guidelines and hospital quality measures for HF include the following medications at discharge: angiotensin converting enzyme inhibitor (ACEI) or Background-Guidelines for heart failure (HF) recommend prescription of guideline-directed medical therapy before hospital discharge; some of these therapies are included in publicly reported performance measures. The burden of new medications for individual patients has not been described. Methods and Results-We used Get With The Guidelines-HF registry data from 2008 to 2013 to characterize prescribing, indications, and contraindications for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, β-blockers, aldosterone antagonists, hydralazine/isosorbide dinitrate, and anticoagulants. The difference between a patient's medication regimen at hospital admission and that recommended by HF quality measures at discharge was calculated. Among 158 922 patients from 271 hospitals with a primary discharge diagnosis of HF, initiation of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was indicated in 18.1% of all patients (55.5% of those eligible at discharge were not receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers at admission), β-blockers in 20.3% (50.5% of eligible), aldosterone antagonists in 24.1% (87.4% of eligible), hydralazine/isosorbide dinitrate in 8.6% (93.1% of eligible), and anticoagulants in 18.0% (58.0% of eligible). Cumulatively, 0.4% of patients were eligible for 5 new medication groups, 4.1% for 4 new medication groups, 9.4% for 3 new medication groups, 10.1% for 2 new medication groups, and 22.7% for 1 new medication group; 15.0% were not eligible for new medications because of adequate prescribing at admission; and 38.4% were not eligible for any medications recommended by HF quality measures. Compared with newly indicated medications (mean, 1.45±1.23), actual new prescriptions were lower (mean, 1.16±1.00). Conclusions-A quarter of patients hospitalized with HF need to start >1 medication to meet HF quality measures. Systems for addressing medication initiation and managing polypharmacy are central to HF transitional care.