title: Guideline-Appropriate Care and In-Hospital Outcomes in Patients With Heart Failure in Teaching and Nonteaching Hospitals: Findings From Get With The Guidelines-Heart Failure.
abstract: Despite increasing awareness regarding evidence-based guidelines, considerable gaps exist for heart failure (HF) quality of care at teaching hospitals (TH) and nonteaching hospitals (NTH). We analyzed data from Get With The Guidelines (GWTG)-HF to compare the rates and trends of guideline-recommended care at TH and NTH for patients with HF.
  
  
  
  Baseline patient characteristics, performance measures, and in-hospital outcomes were compared between 197 187 HF patients admitted to TH and 106 924 patients admitted to NTH between 2005 and 2014. Patients treated in TH were younger and were more likely to be black and uninsured. Defect-free care (defined as 100% compliance with performance measures) was similar in both group of hospitals (crude rates: 88% at TH versus 86% at NTH, adjusted odds ratio 0.99, 95% confidence interval 0.73-1.34) as were individual performance measures: discharge instruction, documentation of ejection fraction, use of angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists, use of β-blocker, and smoking cessation counseling. During the study period, there was improvement in adherence with performance measures over time, with no significant difference at TH (adjusted odds ratio 1.20, 95% confidence interval 1.11-1.30;P<0.01) and NTH (adjusted odds ratio 1.09, 95% confidence interval 1.02-1.17;P=0.01; interactionPvalue 0.07).
  
  
  
  Data from the GWTG-HF program suggest that there was improving and comparable adherence with HF performance measures and use of guideline-recommended therapies irrespective of hospital teaching status.
authors: From the Virginia Commonwealth University, Richmond, VA (D.B.P., R.M.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Duke University School of Medicine, Durham, NC and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.L., P.J.S., A.D.D., A.F.H.); VA Palo Alto Health Care System, Palo Alto, CA (P.A.H.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.).
authors: Dhavalkumar B
authors: DB
authors: Patel
authors: From the Virginia Commonwealth University, Richmond, VA (D.B.P., R.M.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Duke University School of Medicine, Durham, NC and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.L., P.J.S., A.D.D., A.F.H.); VA Palo Alto Health Care System, Palo Alto, CA (P.A.H.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.).
authors: Rachit M
authors: RM
authors: Shah
authors: From the Virginia Commonwealth University, Richmond, VA (D.B.P., R.M.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Duke University School of Medicine, Durham, NC and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.L., P.J.S., A.D.D., A.F.H.); VA Palo Alto Health Care System, Palo Alto, CA (P.A.H.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.).
authors: Deepak L
authors: DL
authors: Bhatt
authors: From the Virginia Commonwealth University, Richmond, VA (D.B.P., R.M.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Duke University School of Medicine, Durham, NC and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.L., P.J.S., A.D.D., A.F.H.); VA Palo Alto Health Care System, Palo Alto, CA (P.A.H.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.).
authors: Li
authors: L
authors: Liang
authors: From the Virginia Commonwealth University, Richmond, VA (D.B.P., R.M.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Duke University School of Medicine, Durham, NC and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.L., P.J.S., A.D.D., A.F.H.); VA Palo Alto Health Care System, Palo Alto, CA (P.A.H.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.).
authors: Phillip J
authors: PJ
authors: Schulte
authors: From the Virginia Commonwealth University, Richmond, VA (D.B.P., R.M.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Duke University School of Medicine, Durham, NC and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.L., P.J.S., A.D.D., A.F.H.); VA Palo Alto Health Care System, Palo Alto, CA (P.A.H.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.).
authors: Adam D
authors: AD
authors: DeVore
authors: From the Virginia Commonwealth University, Richmond, VA (D.B.P., R.M.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Duke University School of Medicine, Durham, NC and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.L., P.J.S., A.D.D., A.F.H.); VA Palo Alto Health Care System, Palo Alto, CA (P.A.H.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.).
authors: Adrian F
authors: AF
authors: Hernandez
authors: From the Virginia Commonwealth University, Richmond, VA (D.B.P., R.M.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Duke University School of Medicine, Durham, NC and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.L., P.J.S., A.D.D., A.F.H.); VA Palo Alto Health Care System, Palo Alto, CA (P.A.H.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.).
authors: Paul A
authors: PA
authors: Heidenreich
authors: From the Virginia Commonwealth University, Richmond, VA (D.B.P., R.M.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Duke University School of Medicine, Durham, NC and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.L., P.J.S., A.D.D., A.F.H.); VA Palo Alto Health Care System, Palo Alto, CA (P.A.H.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.).
authors: Clyde W
authors: CW
authors: Yancy
authors: From the Virginia Commonwealth University, Richmond, VA (D.B.P., R.M.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Duke University School of Medicine, Durham, NC and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.L., P.J.S., A.D.D., A.F.H.); VA Palo Alto Health Care System, Palo Alto, CA (P.A.H.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.). gfonarow@mednet.ucla.edu.
authors: Gregg C
authors: GC
authors: Fonarow
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016507:Cardiology Service, Hospital / Q000592:standards / Q000639:trends*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003376:Counseling / Q000639:trends; D005260:Female; D019983:Guideline Adherence / Q000592:standards / Q000639:trends*; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006784:Hospitals, Teaching / Q000592:standards / Q000639:trends*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends*; D017064:Process Assessment, Health Care / Q000592:standards / Q000639:trends*; D058996:Quality Improvement / Q000639:trends; D019984:Quality Indicators, Health Care / Q000592:standards / Q000639:trends*; D012307:Risk Factors; D016540:Smoking Cessation; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D002317:Cardiovascular Agents
keywords: compliance/adherence; heart failure; teaching hospital