Quality of care of patients hospitalized with congestive heart failure.
BACKGROUND
Congestive heart failure (CHF) is an increasingly prevalent poor-prognosis condition for which effective interventions are available. It is -therefore important to determine the extent to which patients with CHF receive appropriate care in Australian hospitals and identify ways for improving suboptimal care, if it exists.


OBJECTIVE
To evaluate the quality of in-hospital acute care of patients with CHF using explicit quality indicators based on published guidelines.


METHODS
A retrospective case note review was -performed, involving 216 patients admitted to three teaching hospitals in Brisbane, Queensland, Australia, between October 2000 and April 2001. Outcome measures were process-of-care quality -indicators calculated as proportions of all, or strongly -eligible (ideal), patients who received -specific interventions.


RESULTS
Assessment of underlying causes and acute precipitating factors was undertaken in 86% and 76% of patients, respectively, and objective evaluation of left ventricular function was performed in 62% of patients. Prophylaxis for deep venous thrombosis (DVT) was used in only 29% of ideal patients. Proportions of ideal patients receiving pharmacological treatments at discharge were: (i) angiotensin--converting enzyme inhibitors (ACEi) (82%), (ii) target doses of ACEi (61%), (iii) alternative vasodilators in patients ineligible for ACEi (20%), (iv) beta-blockers (40%) and (v) warfarin (46%).


CONCLUSIONS
Opportunities exist for improving quality of in-hospital care of patients with CHF, -particularly for optimal prescribing of: (i) DVT prophylaxis, (ii) ACEi, (iii) second-line vasodilators, (iv) beta-blockers and (v) warfarin. More research is needed to identify methods for improving quality of in-hospital care.
Scott
I A
IA
Department of Internal Medicine, Princess Alexandra Hospital, and Department of Medicine, University of Queensland, Brisbane, Queensland, Australia. ian_scott@health.qld.gov.au
Denaro
C P
CP
Flores
J L
JL
Bennett
C J
CJ
Hickey
A C
AC
Mudge
A M
AM
Atherton
J
J
D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D011793:Queensland / Q000453:epidemiology; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016277:Ventricular Function, Left
D002317:Cardiovascular Agents