Improving evidence-based care for heart failure in outpatient cardiology practices: primary results of the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF).
BACKGROUND
A treatment gap exists between heart failure (HF) guidelines and the clinical care of patients. The Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) prospectively tested a multidimensional practice-specific performance improvement intervention on the use of guideline-recommended therapies for HF in outpatient cardiology practices.


RESULTS
Performance data were collected in a random sample of HF patients from 167 US outpatient cardiology practices at baseline, longitudinally after intervention at 12 and 24 months, and in single-point-in-time patient cohorts at 6 and 18 months. Participants included 34 810 patients with reduced left ventricular ejection fraction (< or =35%) and chronic HF or previous myocardial infarction. To quantify guideline adherence, 7 quality measures were assessed. Interventions included clinical decision support tools, structured improvement strategies, and chart audits with feedback. The performance improvement intervention resulted in significant improvements in 5 of 7 quality measures at the 24-month assessment compared with baseline: beta-blocker (92.2% versus 86.0%, +6.2%), aldosterone antagonist (60.3% versus 34.5%, +25.1%), cardiac resynchronization therapy (66.3% versus 37.2%, +29.9%), implantable cardioverter-defibrillator (77.5% versus 50.1%, +27.4%), and HF education (72.1% versus 59.5%, +12.6%) (each P<0.001). There were no statistically significant improvements in angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use or anticoagulation for atrial fibrillation. Sensitivity analyses at the patient level and limited to patients with both baseline and 24-month quality measure data yielded similar results. Improvements in the single-point-in-time cohorts were smaller, and there were no concurrent control practices.


CONCLUSIONS
The Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting, a defined and scalable practice-specific performance improvement intervention, was associated with substantial improvements in the use of guideline-recommended therapies in eligible patients with HF in outpatient cardiology practices.


BACKGROUND
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00303979.
Fonarow
Gregg C
GC
Department of Medicine, Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA 90095-1679, USA. gfonarow@mednet.ucla.edu
Albert
Nancy M
NM
Curtis
Anne B
AB
Stough
Wendy Gattis
WG
Gheorghiade
Mihai
M
Heywood
J Thomas
JT
McBride
Mark L
ML
Inge
Patches Johnson
PJ
Mehra
Mandeep R
MR
O'Connor
Christopher M
CM
Reynolds
Dwight
D
Walsh
Mary Norine
MN
Yancy
Clyde W
CW
D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000592:standards* / Q000639:trends; D000554:Ambulatory Care Facilities / Q000592:standards* / Q000639:trends; D002309:Cardiology / Q000592:standards* / Q000639:trends; D015331:Cohort Studies; D019317:Evidence-Based Medicine / Q000592:standards* / Q000639:trends; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards; D011446:Prospective Studies; D012042:Registries / Q000592:standards*