Hospitals Improve Heart Failure Outcome by Following National Guidelines

LOS ANGELES -- An initiative to integrate evidence-based care into the hospital treatment of heart failure patients met with a modicum of success, found investigators here.

LOS ANGELES, July 30 -- For heart failure patients, an initiative to integrate national evidence-based optimal care into hospital treatment met with a modicum of success, found investigators here.

The performance-improvement initiative led to shorter hospital stays and a trend toward improved inpatient and post-discharge mortality, reported Gregg C. Fonarow, M.D., of UCLA, for the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF) investigators.

A total of 259 hospitals in the U.S. participated in the initiative, the investigators reported in the July 23 issue of the Archives of Internal Medicine. They submitted data on 48,612 patients with heart failure admitted between March 1, 2003 and Dec. 31, 2004. The investigators combined a comprehensive patient registry with a performance-improvement program and assessed outcomes.

OPTIMIZE-HF represents an effort to help bridge a treatment gap for many patients with heart failure who do not receive life-prolonging agents despite compelling scientific evidence and readily accessible national guidelines.

"OPTIMIZE-HF has shown that evidence-based, guideline-recommended heart failure therapies can be initiated in most real-world patients hospitalized with heart failure and that significant improvements in care can be achieved over time," they wrote.

The OPTIMIZE-HF investigators recorded admission, in-hospital and discharge care and they collected outcomes data using a Web-based registry.

The registry provided real-time feedback on performance measures to the participating institutions, allowing them to compare their performance with other hospitals in the study. The OPTIMIZE-HF team provided the centers with evidence-based, best-practice algorithms, as well as admission and discharge checklists, which they could customize to fit their own settings.

Among the findings at two years:

  • Provision of complete discharge instructions increased significantly, from 46.8% at baseline to 66.5% (P

The authors noted several limitations of the study:

  • "Registry data relied on self reporting by hospitals as opposed to abstraction from medical records by independent operators and had no method for separate verification of complete case ascertainment."
  • "OPTIMIZE-HF was not a randomized clinical trial with a concurrent control group, and the improvements in performance measures may have been influenced by secular trends and concurrent factors other than participation in the study."