Quality of care for Medicare patients hospitalized with heart failure in rural Georgia.
BACKGROUND
It is not known whether quality of care for congestive heart failure (CHF) at rural hospitals is similar to that in larger, urban hospitals.


METHODS
We reviewed hospital charts for 310 Medicare patients hospitalized with CHF at six hospitals in rural Georgia.


RESULTS
Of the 310 patients, 101 (33%) had left ventricular systolic dysfunction, and 60 (19%) had preserved systolic function. Information on left ventricular function was not available for 48% (range, 29% to 87% across the six hospitals). Among patients with systolic dysfunction, 77% were prescribed an angiotensin converting enzyme (ACE) inhibitor at discharge, and 73% were prescribed digoxin. However, the mean daily ACE inhibitor dose was only 48% of the recommended target dose. Only 30% of all patients with atrial fibrillation were prescribed warfarin.


CONCLUSIONS
Overall quality of care for CHF at rural hospitals appears similar to that in other settings, though many patients may not receive evaluation of ventricular function.
Baker
D W
DW
Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Fitzgerald
D
D
Moore
C L
CL
D000368:Aged; D000465:Algorithms; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000925:Anticoagulants / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D004077:Digoxin / Q000627:therapeutic use*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005845:Georgia; D006333:Heart Failure / Q000188:drug therapy*; D006780:Hospitals, Rural; D006801:Humans; D008297:Male; D008499:Medical Records; D006278:Medicare; D011787:Quality of Health Care; D012189:Retrospective Studies; D014481:United States; D018754:Ventricular Dysfunction / Q000145:classification / Q000188:drug therapy; D014859:Warfarin / Q000627:therapeutic use
D000806:Angiotensin-Converting Enzyme Inhibitors; D000925:Anticoagulants; D002316:Cardiotonic Agents; D014859:Warfarin; D004077:Digoxin