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Hospital Performance Measures for Heart Failure not Associated with Improved Outcome
Written by Jeanne Bohm, Ph.D.   

A majority of hospital performance measures for heart failure do not appear to accurately reflect the quality of care provided, according to a study in the January 3 issue of JAMA.

Heart failure is the leading cause of hospitalization in persons older than 65 years, with almost 3.6 million hospitalizations a year attributed to heart failure. Evidence-based therapies shown to improve clinical outcomes are important in treating heart failure. 

The American College of Cardiology and the American Heart Association (ACC/AHA) have developed clinical practice guidelines outlining diagnostic and therapeutic interventions for patients with heart failure. The recently released ACC/AHA Clinical Performance Measures for Adults With Chronic Heart Failure includes: discharge instructions, evaluation of left ventricular systolic function, angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) for left ventricular systolic dysfunction (LVSD), adult smoking cessation advice/counseling, and anticoagulant at discharge for patients with atrial fibrillation. 

Gregg C. Fonarow, M.D., of the University of California Los Angeles Medical Center, and colleagues analyzed data from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry to determine the relationship between current ACC/AHA performance measures and relevant patient clinical outcomes. Data were collected from 5,791 patients at 91 U.S. hospitals between March 2003 and December 2004. The researchers also evaluated the potential performance measure for beta-blockers at discharge. 

During follow-up, 8.6 percent of the patients had died and the total death or rehospitalization rate was 36.2 percent. None of the current ACC/AHA performance measures was a significant independent predictor of death in the first 60 to 90 days after hospital discharge. However prescription of a beta-blocker at the time of hospital discharge was highly predictive of improved postdischarge survival (52 percent reduced risk of death) and a 27 percent lower risk of death/rehospitalization. 

The authors concluded that for the ACC/AHA performance measure sets to achieve their goals, better methods for identifying and validating new performance measures are needed.


JAMA Media Release

Association Between Performance Measures and Clinical Outcomes for Patients Hospitalized With Heart Failure. JAMA. 2007;297:61-70.


About the Author

Jeanne Bohm, Ph.D. is a cancer biologist by training, a medical writer and an experienced science educator.

The author has no financial relationship to any of the companies listed in the article.  

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