Utility of daily diuretic orders for identifying acute decompensated heart failure patients for quality improvement.
BACKGROUND
Many studies have demonstrated gaps in adherence to American College of Cardiology (ACC)/American Heart Association (AHA) guidelines among patients with acute decompensated heart failure (ADHF). Quality improvement initiatives can improve compliance with guideline-recommended therapy yet a major challenge to such programs is identifying heart failure patients across the many wards and services of the complex hospital environment.


RESULTS
Using our hospital's electronic order-entry system, we generated a daily list of all hospitalized patients receiving a loop diuretic. Over a 3-month period, each patient on this list was screened through chart review for a diagnosis of ADHF. For those patients with ADHF, a clinical reminder about ACC/AHA recommended therapies was placed in the chart. Patient outcomes were followed using the Get With The Guidelines heart failure database.During the study period, 98.6% of patients with ADHF were identified by the diuretics list. The diuretics list had a sensitivity of 98.6% and specificity of 92.2%. The diuretic list captured more ADHF patients than alternative methods such as chest x-ray and brain natriuretic peptide level. Use of the daily diuretic list and targeted reminders to clinicians was associated with an improvement in recommended therapies including smoking-cessation education and heart failure teaching.


CONCLUSIONS
A daily list of inpatients receiving diuretics allowed real-time identification of most hospitalized heart failure patients at our institution. Targeted reminders to clinicians regarding ACC/AHA-recommended therapies for heart failure were associated with improvements in guideline adherence.
Campbell
Patrick T
PT
Cardiovascular Division, University of Connecticut Health Center, John Dempsey Hospital, 260 Farmington Ave., Farmington, CT 06030, USA. pacampbell@uchc.edu
Tremaglio
Joseph
J
Bhardwaj
Adarsh
A
Ryan
Jason
J
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000572:American Heart Association; D015331:Cohort Studies; D004232:Diuretics / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011379:Prognosis; D058996:Quality Improvement / Q000592:standards*; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States
D004232:Diuretics