What is the clinical evidence from this study?

Study design: Observational. Population: Heart failure (n=289810). Primary outcome: Adherence to 2020 ACC/AHA performance measures for heart failure.

What does this research mean for the field?

Significant treatment gaps exist in contemporary inpatient heart failure care, characterized by low utilization of newer therapies like ARNIs (6.0% of eligible patients) and poor achievement of target medication doses for guideline-directed medical therapies. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate adherence to contemporary inpatient quality-of-care and performance measures among hospitalized heart failure patients across the Veterans Affairs healthcare system.

October 1, 2022Circulation Cardiovascular Quality and OutcomesOpen Access

Inpatient Quality-of-Care Measures for Heart Failure: Treatment Gaps and Opportunities in the Contemporary Era

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Key result

Heart failure hospitalizations reveal significant treatment gaps, including only 6% ARNI use among eligible patients.

n=289,810

Why the study?

The 2020 American College of Cardiology/AHA performance measures for heart failure provided a new set of quality-of-care tools, prompting an evaluation of their achievement within the Veterans Affairs hospital system.

Key Points

To evaluate adherence to contemporary inpatient quality-of-care and performance measures among hospitalized heart failure patients across the Veterans Affairs healthcare system.
Retrospective cohort analysis of electronic health records from hospital discharges with a primary heart failure diagnosis between January 2010 and February 2021 (N=289,810).
Evaluated adherence to standardized ACC/AHA quality metrics, target dosing attainment, and site-level variations across hospital facilities.
Among patients with reduced ejection fraction (53.0%), beta-blocker use was high at 89.0%, but combined ACE inhibitor, ARB, or ARNI use decreased over time from 75.3% in 2010 to 55.8% in 2020.
While 68.1% were eligible for ARNI, only 6.0% received them (reaching 17.2% by 2020), and hydralazine/nitrate prescription among eligible Black patients was low at 19.3%.
Attainment of ≥50% target dosing remained low (beta-blockers: 45.9%, ACE inhibitors/ARBs: 31.6%, ARNIs: 19.0%), accompanied by notable hospital site-level disparities in medication prescription and cardiac rehabilitation referral (10.5%).

Study Design

Type

Observational (n=289,810)

Multicenter

Yes

Structured PICO

Population

289,810 hospital discharges from January 2010 to February 2021 with a primary diagnosis of heart failure within the Veterans Affairs hospital system

Intervention

Evaluation of adherence to 2020 American College of Cardiology/AHA performance measures for heart failure

Outcome

Achievement of performance measures (adherence to guideline-directed medical therapy, target dosing, discharge appointments, and cardiac rehabilitation referral)

Significant treatment gaps and site-level variations exist in the implementation of guideline-directed medical therapies for heart failure within the Veterans Affairs system, highlighting opportunities for quality improvement.

Discussion

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Implication

GDMT gaps in VA HF care warrant targeted QI; leaves open whether interventions improve uptake in large integrated systems.

Cite This Study

Warner et al. (2022) conducted an observational in Heart failure (n=289,810). Evaluation of 289,810 heart failure hospitalizations revealed significant treatment gaps, including low ARNI use (6.0% of eligible patients) and low target dose achievement for beta blockers (45.9%).

synapsesocial.com/papers/6a182f6dcf49e78c48b4e71a https://doi.org/10.1161/circoutcomes.122.008936

Topics

HFrEF treatment Heart failure HFpEF management Heart failure hospitalization

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Inpatient Quality-of-Care Measures for Heart Failure: Treatment Gaps and Opportunities in the Contemporary Era

Key Points

Study Design

Structured PICO

Discussion

Implication

Cite This Study

Topics

Inpatient Quality-of-Care Measures for Heart Failure: Treatment Gaps and Opportunities in the Contemporary Era

Key Points

Study Design

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider