Chronic Disease

Evidence-based care processes are associated with improved outcomes for heart failure

Heart failure is an expensive, difficult-to-manage condition that costs Medicare more to treat than any other condition. Various performance measures have been established to improve the care of heart failure patients in the hospital. A recent study took a look at some of these processes of care to see how well they improved outcomes after patients were discharged. Measures related to drug therapy, particularly when they are based on clinical evidence, are the most helpful, according to the study.

Researchers reviewed Medicare data on 20,441 patients listed in a heart failure registry as well as process-of-care information. They selected six performance measures to examine. These included any beta-blocker or any evidence-based beta-blocker given at discharge for left ventricular systolic dysfunction (LVSD), warfarin (a blood thinner) for patients with atrial fibrillation, and an aldosterone antagonist for patients with LVSD. Two nondrug performance measures were implanting a cardioverter-defibrillator (ICD) in patients with left ventricular ejection fraction of 35 percent or less (normal ejection fraction, a measure of the heart's pumping power, is 50-70 percent) and referral to a heart failure disease management program. They measured hospital adherence to each process of care and several patient outcomes: mortality at 1 year after discharge, 1-year cardiovascular readmission rates, and 60-day mortality and cardiovascular readmission rates.

Hospital adherence rates varied widely for the six performance measures. The highest rate was for any beta-blocker (82 percent), while the lowest rate was found for disease management referral (7 percent). Uses of any beta-blocker, evidence-based beta-blocker, aldosterone antagonist, and ICD were significantly associated with lower 1-year mortality. For every 10 percent increase in one of these performance measures, there was a 5 to 8 percent lower risk of dying at 1 year after hospital discharge. These four processes-of-care measures can be used to evaluate hospital-level quality of care for heart failure and should be considered for inclusion in all heart failure programs, suggest the study authors. Their study was supported in part by the Agency for Healthcare Research and Quality (HS10548).

See "Relationships between emerging measures of heart failure processes of care and clinical outcomes," by Adrian F. Hernandez, M.D., M.H.S., Bradley G. Hammill, M.S., Eric D. Peterson, M.D., M.P.H., and others in the March 2010 American Heart Journal 159, pp. 406-413.

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