title: Adherence to guideline-recommended adjunctive heart failure therapies among outpatient cardiology practices (findings from IMPROVE HF).
abstract: Although previous studies have documented adherence with certain established heart failure (HF) quality metrics in outpatient cardiology practices, the extent to which there is conformity with other evidence-based, guideline-driven quality metrics in outpatients with HF is unknown. IMPROVE HF is a prospective cohort study designed to characterize the current management of patients with chronic HF and left ventricular ejection fraction <or=35% in outpatient cardiology practices. We evaluated baseline data for conformity with adjunctive HF therapies including pneumococcal vaccinization, hydralazine/isosorbide dinitrate (HYD/ISDN) for Black patients, statin therapy, antiplatelet therapy, smoking-cessation counseling, low-density lipoprotein cholesterol levels (<100 mg/dl), and systolic blood pressure decrease (all patients <140 mm Hg or [optimal] <130 mm Hg). Baseline data were available for 15,381 patients attending 167 cardiology practices. Patient characteristics included a median age 70 years, 71.0% men, 9.1% Black patients, 65.2% with ischemic HF cause, and 61.7% with a history of hypertension. Mean adherences or documentations of adherence were only 7.3% for HYD/ISDN and 1.0% for pneumococcal vaccination. Adherence to other adjunctive therapies ranged from 27.4% to 82.0% but none of the adjunctive treatment interventions were associated with high levels of adherence. Conformity with guideline-recommended, adjunctive HF therapies is deficient in the management of outpatients with HF. Critical gaps in documentation or delivery of care exist, especially for the use of pneumococcal vaccination and HYD/ISDN. In conclusion, improved processes of care, better documentation, and/or increased measures to promote adherence to all primary and adjunctive therapies for HF are needed.
authors.affiliation: Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas, USA. clydey@baylorhealth.edu
authors.forename: Clyde W
authors.initials: CW
authors.lastname: Yancy
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Albert
authors.forename: Anne B
authors.initials: AB
authors.lastname: Curtis
authors.forename: Wendy Gattis
authors.initials: WG
authors.lastname: Stough
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Heywood
authors.forename: Mark L
authors.initials: ML
authors.lastname: McBride
authors.forename: Mandeep R
authors.initials: MR
authors.lastname: Mehra
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: Dwight
authors.initials: D
authors.lastname: Reynolds
authors.forename: Mary Norine
authors.initials: MN
authors.lastname: Walsh
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration*; D044383:Black People / Q000706:statistics & numerical data; D016507:Cardiology Service, Hospital; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States; D001741:Black or African American