Improving Evidence-Based Care for Heart Failure in Outpatient Cardiology Practices

Authors:
  • NANancy M. Albert
    Nancy M. Albert
  • ACAnne B. Curtis
    Anne B. Curtis
  • WSWendy Gattis Stough
    Wendy Gattis Stough
  • MGMihai Gheorghiade
    Mihai Gheorghiade
  • JHJ. Thomas Heywood
    J. Thomas Heywood
  • MMMark L. McBride
    Mark L. McBride
  • PIPatches Johnson Inge
    Patches Johnson Inge
  • COChristopher M. O'COnnor
    Christopher M. O'COnnor
  • DRDwight Reynolds
    Dwight Reynolds
  • MWMary Norine Walsh
    Mary Norine Walsh
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Abstract
Background— A treatment gap exists between heart failure (HF) guidelines and the clinical care of patients. The Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) prospectively tested a multidimensional practice-specific performance improvement intervention on the use of guideline-recommended therapies for HF in outpatient cardiology practices. Methods and Results— Performance data were collected in a random sample of HF patients from 167 US outpatient cardiology practices at baseline, longitudinally after intervention at 12 and 24 months, and in single-point-in-time patient cohorts at 6 and 18 months. Participants included 34 810 patients with reduced left ventricular ejection fraction (≤35%) and chronic HF or previous myocardial infarction. To quantify guideline adherence, 7 quality measures were assessed. Interventions included clinical decision support tools, structured improvement strategies, and chart audits with feedback. The performance improvement intervention resulted in significant improvements in 5 of 7 quality measures at the 24-month assessment compared with baseline: β-blocker (92.2% versus 86.0%, +6.2%), aldosterone antagonist (60.3% versus 34.5%, +25.1%), cardiac resynchronization therapy (66.3% versus 37.2%, +29.9%), implantable cardioverter-defibrillator (77.5% versus 50.1%, +27.4%), and HF education (72.1% versus 59.5%, +12.6%) (each P Conclusions— The Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting, a defined and scalable practice-specific performance improvement intervention, was associated with substantial improvements in the use of guideline-recommended therapies in eligible patients with HF in outpatient cardiology practices. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00303979.

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