Heart failure care in the outpatient cardiology practice setting: findings from IMPROVE HF.
BACKGROUND
Few data exist regarding contemporary care patterns for heart failure (HF) in the outpatient setting. IMPROVE HF is a prospective cohort study designed to characterize current management of patients with chronic HF and ejection fraction < or =35% in a national registry of 167 US outpatient cardiology practices.


RESULTS
Baseline patient characteristics and data on care of 15381 patients with diagnosed HF or prior myocardial infarction and left ventricular dysfunction were collected by chart abstraction. To quantify use of therapies, 7 individual metrics (use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker, aldosterone antagonist, anticoagulation, implantable cardioverter defibrillator, cardiac resynchronization therapy, and HF education) and composite metrics were assessed. Care metrics include only patients documented to be eligible and without contraindications or intolerance. Among practices, 69% were nonteaching. Patients were 71% male, with a median age of 70 years, and a median ejection fraction of 25%. Use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (80%) and beta-blocker (86%) was relatively high in eligible patients in the outpatient cardiology setting; other metrics, such as aldosterone antagonist (36%), device therapy (implantable cardioverter defibrillator/cardiac resynchronization therapy with defibrillator, 51%; cardiac resynchronization therapy, 39%), and education (61%), showed lower rates of use. A median 27% of patients received all HF therapies for which they were potentially eligible on the basis of chart documentation. Use of guideline-recommended therapies by practices varied widely.


CONCLUSIONS
These data are among the first to assess treatment in the outpatient setting since the release of the latest national HF guidelines and to demonstrate substantial variation among cardiology practices in the documented therapies provided to HF patients.
Fonarow
Gregg C
GC
Department of Medicine, Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA 90095-1679, USA. gfonarow@mednet.ucla.edu
Yancy
Clyde W
CW
Albert
Nancy M
NM
Curtis
Anne B
AB
Stough
Wendy Gattis
WG
Gheorghiade
Mihai
M
Heywood
J Thomas
JT
McBride
Mark L
ML
Mehra
Mandeep R
MR
O'Connor
Christopher M
CM
Reynolds
Dwight
D
Walsh
Mary Norine
MN
D000368:Aged; D000553:Ambulatory Care / Q000592:standards*; D002309:Cardiology / Q000379:methods* / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008297:Male; D009017:Morbidity; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000379:methods*; D014481:United States / Q000453:epidemiology