title: Quality of heart failure care in managed Medicare and Medicaid patients in North Carolina.
abstract: Use of angiotensin-converting enzyme (ACE) inhibitors and beta-adrenergic receptor blockers in patients with heart failure (HF) remains low despite the results of clinical trials and evidence-based guidelines that support their use. The quality of HF care in managed Medicare and Medicaid programs in North Carolina participating in a HF quality improvement program was assessed. Managed care plans identified adult patients with 1 inpatient or 3 outpatient claims for HF during 2000. A stratified random sample of 971 Medicare and 642 Medicaid patients' outpatient medical records from 5 plans were reviewed by trained nurse abstractors to obtain data regarding type of HF, demographics, comorbidities, and therapies. Left ventricular function assessment was performed in 88% of patients. Among 494 patients with systolic dysfunction, 86% were appropriately treated with respect to ACE inhibitors (73% prescribed, 13% had a documented contraindication). In contrast, beta-blocker therapy was appropriate in 61% (49% prescribed, 12% contraindication). There were no significant differences in drug use by insurance, gender, race, or age. Ventricular function assessment and ACE inhibitor prescription rates are higher than beta-blocker prescription rates among Medicare and Medicaid managed care patients in North Carolina. Opportunities for improvement remain, particularly for beta-blocker use.
authors.affiliation: Department of Public Health Sciences, Winston-Salem, North Carolina, USA.
authors.forename: Alain G
authors.initials: AG
authors.lastname: Bertoni
authors.forename: Vanessa
authors.initials: V
authors.lastname: Duren-Winfield
authors.forename: Walter T
authors.initials: WT
authors.lastname: Ambrosius
authors.forename: Jill
authors.initials: J
authors.lastname: McArdle
authors.forename: Carla A
authors.initials: CA
authors.lastname: Sueta
authors.forename: Mark W
authors.initials: MW
authors.lastname: Massing
authors.forename: Sharon
authors.initials: S
authors.lastname: Peacock
authors.forename: Jennifer
authors.initials: J
authors.lastname: Davis
authors.forename: Janet B
authors.initials: JB
authors.lastname: Croft
authors.forename: David C
authors.initials: DC
authors.lastname: Goff
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000592:standards*; D008484:Medicaid / Q000592:standards*; D008499:Medical Records; D006278:Medicare / Q000592:standards*; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D017749:Total Quality Management
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors