Quality of care in African-American patients admitted for congestive heart failure at a university teaching hospital.
Previous studies have shown that the quality of congestive heart failure (CHF) treatment for hospitalized patients varies. The goal of this study was to evaluate the compliance of physicians at a large, inner-city teaching hospital with current evidence-based guidelines. A retrospective review of the medical records of 104 patients admitted with CHF was conducted. Quality-of-care indicators were assessed, including the use of echocardiograms, the administration of angiotensin-converting enzyme (ACE) inhibitors and beta blockers to appropriate patients, and lifestyle and medication counseling at discharge. The assessment of left ventricular (LV) function was documented in 96.1% of patients (n = 100). A total of 65 patients (92.8%) with systolic dysfunction were considered to be ideal candidates for ACE inhibitor therapy. Of these 65 patients, 58 (89.2%) were discharged on ACE inhibitors. Of 41 patients with LV systolic dysfunction who were considered to be ideal candidates for beta-blocker therapy, only 10 (24.4%) were discharged on beta-blocker therapy. Of all patients with CHF, 50% received discharge counseling on medication compliance, 48% received counseling on a low-salt diet, and only 9% were told to monitor daily weight. This study shows that in a major academic teaching hospital, there is a need for improvement in the use of beta-blocker therapy as well as greater emphasis on patient education strategies regarding diet, medication adherence, and monitoring daily weight.
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Nurcan
N
Ilksoy
Renee H
RH
Moore
Kirk
K
Easley
Terry A
TA
Jacobson
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D001741:Black or African American; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001835:Body Weight; D003376:Counseling; D004039:Diet, Sodium-Restricted; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D005845:Georgia; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy / Q000208:ethnology* / Q000503:physiopathology / Q000628:therapy*; D006785:Hospitals, University / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000592:standards; D010349:Patient Compliance; D010353:Patient Education as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards; D012189:Retrospective Studies; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000208:ethnology / Q000628:therapy
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics