BOSTON — Performance improvement intervention for outpatient care of heart failure patients increases the use of evidence-based, guideline-recommended processes and therapies, Dr. Clyde W. Yancy said at the annual meeting of the Heart Failure Society of America.
Provision of prompts, pocket cards, check lists, and guideline-based decision-support algorithms significantly increases the likelihood that physicians will use evidence-based therapies, devices, and patient education, according to primary findings from the large-scale, prospective IMPROVE-HF (Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting) study.
To assess conformity with established heart failure (HF) performance measures based on class I recommendations of the national HF guidelines (Circulation 2005;112:e154–235), the IMPROVE-HF investigators reviewed the charts of 35,000 HF outpatients treated at the study's 167 sites at baseline, then 12 and 24 months after the implementation of the practice-specific process-of-care initiative, said Dr. Yancy of Baylor University Medical Center at Dallas.
The baseline findings suggested suboptimal conformity with performance measures for all of the practices considered, and significant variation in the use of evidence-based, guideline-recommended therapies, especially for women and the elderly. Large variations were observed in the use of anticoagulation for atrial fibrillation, implantable cardioverter defibrillators (ICDs), cardiac resynchronization therapy (CRT), and HF education. In all, only 27% of patients who were assessed with HF at baseline were receiving treatments for which they were eligible, based on the guidelines, Dr. Yancy reported.
But 24 months after the start of the initiative, significantly more patients received treatments for which they were eligible, across nearly all measures, Dr. Yancy said. The largest changes were observed in the use of ICDs, aldosterone receptor antagonists, and CRT, from 39%, 35%, and 50% of eligible patients, respectively, to 68%, 60%, and 56%. Use of ACE inhibitors or angiotensin receptor blockers and beta-blockers, and the provision of HF education, also improved significantly.
Dr. Yancy reported having no financial disclosures relative to his presentation. The IMPROVE-HF study is supported by Medtronic Inc.
After 24 months, significantly more patients received treatments for which they were eligible.
Source DR. YANCY