Degree to which American doctors follow national care guidelines for patients with heart failure correlates strongly with post-hospital outcome
There is a high degree of variability in
care for US patients with heart failure, and mortality rates correlate
with the extent to which national guidelines are followed, according
to an article in the July 11 issue of the Archives of Internal Medicine.
The American researchers compared four standard measures for heart
failure treatment used by the Joint Commission of Accreditation
of Healthcare Organizations, the national agency that accredits
hospitals.
“We found that the quality of care for heart
failure treatment really depends to a very large extent on which
hospital patients are admitted to. This is one of the first studies
to take a scientific look at the variation in performance measures
in hospitals across the country,” said Gregg C. Fonarow, MD, lead
study author.
Using a national registry of heart failure
patients called the Acute Decompensated Heart Failure National Registry
(ADHERER), researchers analyzed admissions data from 223 U.S. hospitals
and assessed whether hospitals performed four standard measures
in heart failure treatment:
Regarding supplying the patient or caregiver
with written instructions and guidance on post-discharge care, only
24 percent of patients hospitalized received complete discharge
instructions. In contrast, 86.2 percent of patients hospitalized
had their heart function assessed and 72 percent of eligible patients
received a prescription for an angiotensin-converting enzyme (ACE)
inhibitor drug upon discharge. Only 43.2 percent of patients who
were current or recent smokers were counseled regarding smoking
cessation.
Fonarow said that the study compared variation
in clinical outcomes as well, including length of stay and mortality
rates. “Whether a patient makes it out of the hospital alive or
not after being hospitalized with heart failure varies by the hospital
they go to,” said Fonarow.
The difference in mortality rates between
hospitals was four-fold, with variations from only 1.4 percent of
patients dying at the best performing hospitals to as high as 6.1
percent of patients at the worst performing institutions.
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