BOSTON — A performance-improvement intervention for the outpatient care of heart failure patients increased the use of evidence-based treatment in the prospective IMPROVE-HF (Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting) study.
The investigators reviewed the charts of 35,000 HF outpatients treated at the study's 167 sites at baseline, then 12 and 24 months after implementation of a practice-specific process-of-care initiative, Dr. Clyde W. Yancy said at the annual meeting of the Heart Failure Society of America. A baseline assessment suggested suboptimal conformity with established heart failure (HF) performance measures for all of the practices, based on class I recommendations of the national HF guidelines (Circulation 2005;112:e154–235). The use of evidence-based, guideline-recommended therapies varied significantly, especially for women and the elderly.
Large variations were observed in the use of anticoagulation for atrial fibrillation, implantable cardioverter defibrillators (ICDs), cardiac resynchronization therapy (CRT), and HF education. In all, only 27% of patients with HF at baseline were receiving treatments for which they were eligible, based on the guidelines, said Dr. Yancy of Baylor University Medical Center at Dallas.
But 24 months after the start of the performance improvement program, which included prompts, pocket cards, checklists, and decision-support algorithms, significantly more patients received treatments for which they were eligible, across nearly all measures. The largest changes were observed in the use of ICDs, aldosterone receptor antagonists, and CRT, from 39%, 35%, and 50% of eligible patients, respectively, to 68%, 60%, and 56%. The use of ACE inhibitors or angiotensin receptor blockers and beta-blockers, and the provision of HF education, also improved significantly, Dr. Yancy reported.
Dr. Yancy reported having no financial disclosures relative to his presentation. The IMPROVE-HF study was supported by Medtronic Inc.