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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