Quality of Care in Patients Hospitalized for Acute Heart Failure: Results From the First Two Years of the “Quality in Cardiology” (Qic) Project

Background Assessing quality of care is the first step toward improving the management of patients with acute heart failure (AHF). The European Society of Cardiology (ESC) has recently defined a set of quality indicators (QIs) for AHF care provided during hospitalization and after discharge. Aim The “Quality in Cardiology” (QiC) Project aimed to evaluate whether systematic measurement of all ESC QIs is feasible in the cardiology department of a secondary–level hospital and whether it is useful for improving patient care. Methods The QiC Project is a prospective, 3–year observational quality improvement study conducted in the Intensive Cardiac Care Unit (ICCU) and Cardiology ward of Pio XI Hospital, Desio. For each admission for AHF, physicians and nurses completed standardized data collection forms including all ESC individual QIs (2 QIs on structural framework, 6 on patient assessment, 5 on initial treatment, and 1 on health–related quality of life). Six–monthly audit meetings involving medical and nursing staff were held based on QI analyses. For each QI, the rate of attainment was evaluated during the first, second, third, and fourth semesters of the project among admissions ending with discharge to home or to a rehabilitation centre. Temporal trends were assessed using the chi–square test for trend, with p ‹ 0.05 considered statistically significant. Results From May 1, 2023, to April 30, 2025, a total of 303 admissions for AHF occurred in the ICCU and Cardiology ward. One patient denied consent, 9 died during hospitalization, 31 had to be transferred to another hospital and 262 were discharged to home or to a rehabilitation centre. Table 1 shows the percentage of QIs achieved in these admissions for each semester. Of the 14 QIs, seven were achieved in more than 90% of admissions across all semesters. Two QIs showed a significant improvement over time: completion of all recommended laboratory tests during hospitalization and prescription of SGLT2 inhibitors at discharge in patients with reduced ventricular function. No QIs showed a worsening trend over time; however, during the fourth semester, educational sessions for patients and their caregivers were discontinued due to low participation (see 2nd QI). Conclusions Quality of care for AHF can be systematically measured in patients admitted to a cardiology department. Periodic audit activities enable identification of critical issues and contribute to improving the quality of care over time.