Evidence-based performance measures for heart failure are increasingly being used to stimulate quality improvement efforts.
A literature search was performed using MEDLINE, EMBASE, Cochrane Review, and a citation review. Research studies that assessed the association between the American College of Cardiology (ACC)/American Heart Association (AHA) heart failure performance measures from the inpatient setting and patient outcomes were examined. Studies were restricted to those conducted within the United States from 2001 until the present and included at least 1 of the ACC/AHA performance measures for chronic heart failure and a clinical outcome as an endpoint. Eleven original studies and 1 literature review met the study inclusion criteria. Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and beta-blocker use at discharge had the strongest association with improved patient outcomes, whereas discharge instructions had a weaker but positive effect.
The findings from this systematic review suggest that an increase in compliance with the heart failure performance measures leads to a consistent positive impact on patient outcomes although the strength, magnitude, and significance of this effect is variable across the individual performance indicators. Further longitudinal studies and additional measure sets may yield deeper insights into the causal relationship between heart failure processes of care and clinical outcomes.
"However, treatment guidelines are adopted slowly and applied inconsistently and may thus not result in the expected improvements in patient care and clinical outcomes [9-12]. Consequently, in many health care systems, major efforts are made to implement recommended guidelines . However, population-based data on the implementation of the recommendations in everyday clinical practice and the possible impact on patient outcomes are still sparse . "
[Show abstract][Hide abstract] ABSTRACT: The treatment of heart failure (HF) is complex and the prognosis remains serious. A range of strategies is used across health care systems to improve the quality of care for HF patients. We present results from a nationwide multidisciplinary initiative to monitor and improve the quality of care and clinical outcome of HF patients using indicator monitoring combined with systematic auditing.
We conducted a nationwide, population-based prospective study using data from the Danish Heart Failure Registry. The registry systematically monitors and audits the use of guideline recommended processes of care at Danish hospital departments treating incident HF patients. We identified patients registered between 2003 and 2010 (n = 24504) and examined changes in use of recommended processes of care and 1-year mortality.
The use of the majority of the recommended processes of care increased substantially from 2003 to 2010: echocardiography (from 62.7% to 90.5%; Relative Risk (RR) 1.45 (95% CI, 1.39-1.50)), New York Heart Association classification (from 29.4% to 85.5%; RR 2.91 (95% CI, 2.69-3.14)), betablockers (from 72.6% to 88.3%; RR 1.23 (95% CI, 1.15-1.29)), physical training (from 5.6% to 22.8%; RR 4.04 (95% CI, 2.96-4.52)), and patient education (from 49.3% to 81.4%; RR 1.65 (95% CI, 1.52-1.80)). Use of ACE/ATII inhibitors remained stable (from 92.0% to 93.2%; RR 1.01 (95% CI, 0.99-1.04)). During the same period, 1-year mortality dropped from 20.5% to 12.8% (adjusted Hazard Ratio 0.79 (95% CI, 0.65-0.96).
Use of guideline recommended processes of care has improved among patients with incident HF included in the Danish Heart Failure Registry between 2003 and 2010. During the same period, a decrease in mortality was observed.
BMC Health Services Research 10/2013; 13(1):391. DOI:10.1186/1472-6963-13-391 · 1.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Guidelines have rather quickly assumed a central role in health care delivery in the U.S. They have become the foundation on which performance measures are built and, therefore, a major player in assessing the quality of care provided by individuals and institutions, the ramifications of which involve reputation, reimbursement, and litigation. We are concerned, however, that in our enthusiasm for collectively endorsing these guidelines, we are marginalizing the importance of physician judgment and inadvertently risking the conversion of guidelines into "cookbooks." We believe that this editorial, while unequivocally acknowledging the fundamental importance of guidelines, simultaneously provides a critically important perspective on the potential for misuse of both guidelines and performance measures. Further, we hope that publication of this commentary will help temper enthusiasm for overzealous conversion of guidelines into performance measures, thereby restoring the vital role of physician judgment and insight into patient management.
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