Evidence-Based Heart Failure Performance Measures and Clinical Outcomes: A Systematic Review

Division of Health Policy & Administration, University of Illinois at Chicago, School of Public Health, Chicago, IL.
Journal of cardiac failure (Impact Factor: 3.05). 05/2010; 16(5):411-8. DOI: 10.1016/j.cardfail.2010.01.005
Source: PubMed


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.

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    • "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 [13]. However, population-based data on the implementation of the recommendations in everyday clinical practice and the possible impact on patient outcomes are still sparse [14]. "
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    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.
    Full-text · Article · Oct 2013 · BMC Health Services Research
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    • "Several cross-sectional studies have provided some insights into hospital performance for heart failure since the widespread implementation of standardized performance measures (Williams et al. 2005; Joint Commission 2007; Jha et al. 2005; Kroch et al. 2007). These reports suggest that there have been substantial improvements in hospital performance (Williams et al. 2005; Joint Commission 2007; Jha et al. 2005; Kroch et al. 2007); however, little is known about the relationship between increased hospital performance and patient outcomes from longitudinal studies, as well as the potential mediators of performance (Maeda 2010). The performance measures for heart failure are based on clinical research studies that have been demonstrated to decrease morbidity and mortality of left ventricular systolic dysfunction (LVSD) (Bonow et al. 2005). "
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    ABSTRACT: Using data from the Joint Commission's ORYX initiative and the Medicare Provider Analysis and Review file from 2003 to 2006, this study employed a fixed-effects approach to examine the relationship between hospital market competition, evidence-based performance measures, and short-term mortality at seven days, 30 days, 90 days, and one year for patients with chronic heart failure. We found that, on average, higher adherence with most of the Joint Commission's heart failure performance measures was not associated with lower mortality; the level of market competition also was not associated with any differences in mortality. However, higher adherence with the discharge instructions and left ventricular function assessment indicators at the 80th and 90th percentiles of the mortality distribution was associated with incrementally lower mortality rates. These findings suggest that targeting evidence-based processes of care might have a stronger impact in improving patient outcomes.
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