Key result
Implementation of a cardiology quality incentive program significantly improved adherence to composite guideline-directed medical therapy for HFrEF compared to baseline (OR 2.285).
Why the study?
Adherence to GDMT is central to quality-improvement programs, but the impact of financial incentive programs has been mixed.
Does a cardiology quality incentive program integrating financial incentives and EHR decision support improve adherence to guideline-directed medical therapy in patients with cardiovascular disease?
Observational (n=75,239)
Yes
Does a cardiology quality incentive program integrating financial incentives and EHR decision support improve adherence to guideline-directed medical therapy in patients with cardiovascular disease?
A cardiology quality incentive program integrating financial incentives and EHR decision support significantly improved and sustained adherence to guideline-directed medical therapies for cardiovascular disease and HFrEF.
Program linked to sustained GDMT gains across metrics; supports scalable QI models but leaves open causality without RCTs.
BACKGROUND: Adherence to guideline-directed medical therapy (GDMT) is central to quality-improvement programs, although the impact of financial incentive programs has been mixed. OBJECTIVES: The purpose of this study was to the impact of a cardiovascular population health initiative that integrates financial incentives, robust data infrastructure, and electronic health record clinical decision support on improving GDMT for cardiovascular disease (CVD). METHODS: The program was implemented across 15 ambulatory clinics with 54 cardiologists in an academic health system. Individualized CVD patient panels were created for each provider, and providers received quarterly performance and incentive reports. Quality metrics included antiplatelet and statin or proprotein convertase subtilisin/kexin type 9 inhibitor therapy for atherosclerotic cardiovascular disease prevention, blood pressure control, and GDMT for heart failure with reduced ejection fraction (HFrEF; specified beta blockers; ACEI, ARB, or ARNI; mineralocorticoid receptor antagonist). An interrupted time series analysis evaluated monthly, 1-year, and 2-year changes in the odds of adhering to each specific metric associated with the implementation of the cardiovascular population health program. RESULTS: After the intervention, the composite HFrEF therapy metric improved significantly (2-year odds ratio [OR]: 2.285; 95% confidence interval [CI]: 1.653-3.158; P < 0.001). Individual metrics also improved, including mineralocorticoid receptor antagonist (2-year OR: 3.039; 95% CI: 2.520-3.663; P < 0.001); specified beta blockers (2-year OR: 1.430; 95% CI: 1.129-1.810; P = 0.003); angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, or angiotensin receptor-neprilysin inhibitor therapy for HFrEF (2-year OR: 1.228; 95% CI: 1.001-1.505; P = 0.049); statin or proprotein convertase subtilisin/kexin type 9 inhibitor therapy for atherosclerotic cardiovascular disease (2-year OR: 1.146; 95% CI: 1.092-1.202; P < 0.001); and blood pressure control (2-year OR: 1.496; 95% CI: 1.444-1.550; P < 0.001). CONCLUSIONS: Our program was associated with sustained improvements in GDMT adherence for CVD. It may serve as a scalable model for enhancing the quality of cardiovascular care.
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Cho et al. (2025) conducted an observational in Cardiovascular disease and heart failure with reduced ejection fraction (HFrEF) (n=75,239). Cardiovascular Quality Incentive Program (CQIP) vs. Preintervention baseline was evaluated on Adherence to composite guideline-directed medical therapy for HFrEF (OR 2.285, 95% CI 1.653-3.158, p=<0.001). Implementation of a cardiology quality incentive program significantly improved adherence to composite guideline-directed medical therapy for HFrEF compared to baseline (OR 2.285).
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