title: Quality of heart failure management: a comparison of care between a comprehensive heart failure program and a general cardiology practice.
abstract: This study evaluates adherence to guidelines by heart failure clinicians (HFCs) vs general cardiologists (GCs) for use of implantable cardioverter-defibrillators (ICDs), biventricular pacing devices (cardiac resynchronization therapy; CRT), and use of medications for heart failure (HF). The authors reviewed 563 patients with HF and an ejection fraction <or=35% for adherence to the 2005 American College of Cardiology/American Heart Association HF guidelines for the use of ICDs, CRT, and medications. There were 324 HFC and 239 GC patients. CRT guidelines were appropriately followed in 86% of HFC and 81% of GC patients ( P=NS). For primary arrhythmia prevention, an ICD was implanted in 107 (42%) HFC and 50 (25%) GC patients ( P<.004). Guidelines were appropriately followed in 77% of HFC and 74% of GC patients ( P=NS). For medications, dose intensity of diuretics, beta-blockers, and angiotensin-converting enzyme inhibitors was significantly greater in HFC than GC patients. Guideline-recommended beta-blockers were more frequently utilized by HFCs (97%) than GCs (82%). In conclusion, HFCs and GCs appropriately follow guidelines in the majority of cases, but HFCs use appropriate medications at higher dose intensity.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Asghar
authors.forename: Peter S
authors.initials: PS
authors.lastname: Rahko
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002304:Cardiac Pacing, Artificial; D002309:Cardiology / Q000592:standards / Q000706:statistics & numerical data*; D003325:Coronary Care Units; D017147:Defibrillators, Implantable; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D006305:Health Status Indicators; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume; D016277:Ventricular Function, Left; D014922:Wisconsin
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics