Key result
Hospital-based heart failure quality improvement interventions showed no consistent effect on most process of care measures and clinical outcomes across 14 randomized trials.
Why the study?
The direction, magnitude of effect, and quality of evidence for hospital-based HF quality improvement interventions on process of care measures and clinical outcomes were uncertain.
Do hospital-based quality improvement interventions improve process of care measures and clinical outcomes in patients hospitalized with acute heart failure?
Systematic Review
Do hospital-based quality improvement interventions improve process of care measures and clinical outcomes in patients hospitalized with acute heart failure?
Hospital-based quality improvement interventions for heart failure do not consistently improve process of care measures or clinical outcomes, though the evidence quality is low.
Does not support routine hospital-based heart failure quality improvement programs; challenges broad implementation and leaves open need for refined trial designs.
OBJECTIVE: To estimate the direction and magnitude of effect and quality of evidence for hospital-based heart failure (HF) quality improvement interventions on process of care measures and clinical outcomes among patients with acute HF. REVIEW METHODS: We performed a structured search to identify relevant randomised trials evaluating the effect of in-hospital quality improvement interventions for patients hospitalised with HF through February 2017. Studies were independently reviewed in duplicate for key characteristics, outcomes were summarised and a qualitative synthesis was performed due to substantial heterogeneity. RESULTS: From 3615 records, 14 randomised controlled trials were identified for inclusion with multifaceted interventions. There was a trend towards higher in-hospital use of ACE inhibitors (ACE-I; 57.9%vs40.0%) and beta-blockers (BBs; 46.7%vs10.2%) in the intervention than the comparator in one trial (n=429 participants). Five trials (n=78 727 participants) demonstrated no effect of the intervention on use of ACE-I or angiotensin receptor blocker at discharge. Three trials (n=89 660 participants) reported no effect on use of BB at discharge. Two trials (n=419 participants) demonstrated a trend towards lower hospital readmission up to 90 days after discharge. There was no consistent effect of the quality improvement intervention on 30-day all-cause mortality, hospital length of stay and patient-level health-related quality of life. CONCLUSIONS: Randomised trials of hospital-based HF quality improvement interventions do not show a consistent effect on most process of care measures and clinical outcomes. The overall quality of evidence for the prespecified primary and key secondary outcomes was very low to moderate, suggesting that future research will likely influence these estimates. TRIAL REGISTRATION NUMBER: CRD42016049545.
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Agarwal et al. (2019) conducted a systematic review in Acute heart failure. Hospital-based quality improvement interventions vs. Comparator was evaluated on Process of care measures and clinical outcomes. Hospital-based heart failure quality improvement interventions showed no consistent effect on most process of care measures and clinical outcomes across 14 randomized trials.
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