Improved care for patients with congestive heart failure.
BACKGROUND
Congestive heart failure (CHF) affects 4.9 million people, mostly elderly, in the United States; 550,000 new cases are diagnosed each year. Evidence-based treatment approaches offer opportunities to reduce mortality, complications, and rehospitalization rates.
Seven key components of care tailored to the patient's clinical condition and comorbidities that should be provided to all patients with CHF, in the absence of contraindications or intolerance: (1) left ventricular systolic function assessment, (2) angiotension-converting enzyme-inhibitor or angiotensin receptor blockers at discharge for CHF patients with systolic dysfunction (left ventricular ejection fraction < 40%), (3) anticoagulation at discharge for CHF patients with chronic or recurrent atrial fibrillation, (4) smoking cessation advice and counseling, (5) discharge instructions that address activity level, diet, discharge medications, follow-up appointment, weight monitoring, and what to do if symptoms worsen, (6) influenza immunization (seasonal), and (7) pneumococcal immunization. Hospitals should also consider beta-blocker therapy at discharge for stabilized patients without contraindications.


CONCLUSIONS
The 5 Million Lives Campaign's focus on delivering reliable, evidence-based care for patients with CHF is part of an overall strategy to reduce medically induced harm.
Jacobsen
Diane
D
Institute for Healthcare Improvement, Cambridge, Massachusetts, USA. djacobsen@ihi.org
Sevin
Cory
C
D000359:Aftercare / Q000592:standards; D019317:Evidence-Based Medicine; D005190:Family; D015438:Health Behavior; D006293:Health Promotion; D006333:Heart Failure / Q000188:drug therapy / Q000517:prevention & control*; D006761:Hospitals / Q000592:standards*; D006801:Humans; D009937:Organizational Objectives; D010351:Patient Discharge / Q000592:standards*; D010358:Patient Participation; D010360:Patient Transfer; D011785:Quality Assurance, Health Care / Q000379:methods*; D014481:United States