title: Get With The Guidelines program participation, process of care, and outcome for Medicare patients hospitalized with heart failure.
abstract: BACKGROUND
  Hospitals enrolled in the American Heart Association's Get With The Guidelines Program for heart failure (GWTG-HF) have improved their process of care. However, it is unclear if process of care and outcomes are better in the GWTG-HF hospitals compared with hospitals not enrolled.
  
  
  RESULTS
  We compared hospitals enrolled in GWTG-HF from 2006 to 2007 with other hospitals using data on 4 process of heart failure care measures, 5 noncardiac process measures, risk-adjusted 30-day mortality, and 30-day all-cause readmission after a heart failure hospitalization, as reported by the Center for Medicare and Medicaid Services (CMS). Among the 4460 hospitals reporting data to CMS, 215 (5%) were enrolled in GWTG-HF. Of the 4 CMS heart failure performance measures, GWTG-HF hospitals had significantly higher documentation of the left ventricular ejection fraction (93.4% versus 88.8%), use of angiotensin-converting enzyme inhibitor or angiotensin receptor antagonist (88.3% versus 86.6%), and discharge instructions (74.9% versus 70.5%) (P<0.005 for all). Smoking cessation counseling rates were similar (94.1% versus 94.0%; P=0.51). There was no significant difference in compliance with noncardiac process of care. After heart failure discharge, all-cause readmission at 30 days was 24.5% and mortality at 30 days after admission was 11.1%. After adjustment for hospital characteristics, 30-day mortality rates were no different (P=0.45). However, 30-day readmission was lower for GWTG hospitals (-0.33%; 95% CI, -0.53% to -0.12%; P=0.002).
  
  
  CONCLUSIONS
  Although there was evidence that hospitals enrolled in the GTWG-HF program demonstrated better processes of care than other hospitals, there were few clinically important differences in outcomes. Further identification of opportunities to improve outcomes, and inclusion of these metrics in GTWG-HF, may further support the value of GTWG-HF in improving care for patients with HF.
authors.affiliation: Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA. heiden@stanford.edu
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.forename: Clyde W
authors.initials: CW
authors.lastname: Yancy
authors.forename: Li
authors.initials: L
authors.lastname: Liang
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
mesh_terms: D000572:American Heart Association; D037001:Directive Counseling / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D006761:Hospitals; D006801:Humans; D006278:Medicare; D010349:Patient Compliance / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D017064:Process Assessment, Health Care; D013318:Stroke Volume; D016019:Survival Analysis; D014481:United States; D016277:Ventricular Function, Left