Key result
Hospitalized HF patients show ~83% LVEF assessment adherence but lower compliance for ACE inhibitor dosing.
Why the study?
The standard of care provided by academic medical centers for the management of congestive heart failure was not well characterized.
What is the standard of care and guideline adherence for patients hospitalized with congestive heart failure at academic medical centers?
Observational (n=522)
Yes
What is the standard of care and guideline adherence for patients hospitalized with congestive heart failure at academic medical centers?
Academic medical centers showed good adherence to LVEF assessment and basic education, but significant gaps remained in optimal ACE inhibitor dosing, daily weight monitoring, and smoking cessation counseling.
Highlights ongoing shortfalls in HF discharge care at academic centers; leaves open optimal targets for quality improvement interventions.
BACKGROUND: The purpose of this study was to determine the standard of care provided by academic medical centers for the management of congestive heart failure (CHF). METHODS AND RESULTS: The standard of care was estimated by assessing adherence to the treatment guidelines published by the US Agency for Health Care Policy and Research among 522 patients hospitalized at 7 university hospitals with a diagnosis of CHF. Data were abstracted by retrospective chart review. Of the 522 patients analyzed, 435 (83%) had a left ventricular ejection fraction (LVEF) measured or documented. Among these patients, 192 were considered "ideal" candidates for angiotensin-converting enzyme (ACE) inhibitor therapy (ie, with systolic dysfunction [LVEF <40%] and no contraindications to ACE inhibitors). In this cohort of "ideal" candidates, 138 (72%) were receiving ACE inhibitors at hospital discharge, including 60 (44%) who were prescribed doses recommended in large clinical trials. Compliance with patient education guidelines was assessed in all 487 patients who were alive at the time of discharge. Of these patients, 365 (75%) received dietary counseling, 404 (83%) were educated about exercise, 54 (11%) were instructed to follow daily weights, and 468 (96%) were counseled regarding medication compliance. Among the 87 smokers who were alive at time of discharge, 8 (9%) had documented advice to quit smoking. CONCLUSIONS: This study indicates that academic medical centers performed fairly well on the assessment of LVEF, the prescription of ACE inhibitors at discharge, and on education regarding diet, exercise, and compliance with medications. However, the results suggest opportunities for improvement in ACE inhibitor dosing and patient education regarding the importance of monitoring daily weights and smoking cessation.
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Nohria et al. (1999) conducted an observational in congestive heart failure (CHF) (n=522). Adherence to treatment guidelines was evaluated on Adherence to treatment guidelines (LVEF assessment, ACE inhibitor prescription, and patient education). Among 522 patients hospitalized with heart failure, 83% had LVEF assessed and 72% of eligible candidates received ACE inhibitors at discharge, with lower compliance in dosing and smoking cessation.
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