Evaluating Quality of Care for Patients With Heart Failure

Krumholz, Harlan M.; Baker, David W.; Ashton, Carol M.; Dunbar, Sandra B.; Friesinger, Gottlieb C.; Havranek, Edward P.; Mark, Daniel B.; Konstam, Marvin A.; Ordin, Diana L.; Piña, Ileana L.; Pitt, Betram; Spertus, John A.

doi:10.1161/01.cir.101.12.e122

Cited by 143 publications

(87 citation statements)

References 74 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…28 Cardiologists have reported practices that conform more closely with published guidelines for heart failure management than internists and family practitioners. 3 The greater use of cardiac catheterization by cardiologists than noncardiologists 29 is in accord with practice guidelines to identify reversible causes of heart failure and select patients in whom revascularization may improve survival.…”

Section: Discussionmentioning

confidence: 95%

Care and Outcomes of Patients Newly Hospitalized for Heart Failure in the Community Treated by Cardiologists Compared With Other Specialists

et al. 2003

View full text Add to dashboard Cite

Background-It is not known whether subspecialty care by cardiologists improves outcomes in heart failure patients from the community over care by other physicians. Methods and Results-Using administrative data, we monitored 38 702 consecutive patients with first-time hospitalization for heart failure in Ontario, Canada, between April 1994 and March 1996 and examined differences in processes of care and clinical outcomes between patients attended by physicians of different disciplines. We found that patients attended by cardiologists had lower 1-year risk-adjusted mortality than those attended by general internists, family practitioners, and other physicians (28.5% versus 31.7%, 34.9%, and 35.9%, respectively; all pairwise comparisons, PϽ0.001). The 1-year risk-adjusted composite outcome of death and readmission for heart failure was also lower for the cardiologists compared with family practitioners and other physicians but not general internists (54.7% versus 58.1%, 58.3%, and 55.4%; PϽ0.001, PϽ0.001, and Pϭ0.39, respectively). Multivariable hierarchical modeling demonstrated a significant physician-level effect for both outcomes in favor of the cardiologists, particularly against non-general internists.Cardiologist care was associated with higher adjusted rates of invasive interventions and postdischarge prescriptions of heart failure medications. Conclusions-In this population-based cohort, heart failure patients attended by cardiologists in hospital had lower risk of death as well as the composite risk of death or readmission than patients attended by noncardiologists. These data raise the need to identify specialty-driven differences in processes of care for heart failure patients, which may explain the observed disparity in clinical outcomes that presently favor cardiologist care.

show abstract

Section: Discussionmentioning

confidence: 95%

Care and Outcomes of Patients Newly Hospitalized for Heart Failure in the Community Treated by Cardiologists Compared With Other Specialists

et al. 2003

View full text Add to dashboard Cite

show abstract

“…Thorough discharge planning that includes a special emphasis on ensuring compliance with an evidencebased medication regimen 241 is associated with improved patient outcomes. 242,302,303 Several studies have examined the effect of providing more intensive delivery of discharge instructions coupled tightly with subsequent well-coordinated follow-up care for patients hospitalized with HF, many with positive results. 112,[243][244][245] Comprehensive discharge planning plus postdischarge support for older patients with HF can significantly reduce readmission rates and may improve health outcomes such as survival and quality of life without increasing costs.…”

Section: The Hospital Dischargementioning

confidence: 99%

2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults

Jessup¹,

Abraham²,

Casey³

et al. 2009

Circulation

1,318

538

View full text Add to dashboard Cite

“…[17][18][19] The principal finding of the current study is that there are multiple opportunities to improve the diagnostic evaluation and initial choice of medications for patients with CHF along the lines of the 1994 AHCPR and recent 2001 ACC/AHA guidelines, which were met in full by only 4.7% of our study group. [20][21][22] Although the underlying etiologies of CHF in REACH are not known, we would expect, like in other CHF populations, that the leading cause of CHF is ischemic heart disease. 23 The rates we observed, including overall use of stress testing or catheterization (ischemia evaluation) of < 35%, suggest there is a substantial population of patients with ischemic heart disease who may benefit from vasodilator therapy or revascularization.…”

Section: Discussionmentioning

confidence: 99%

Opportunities for improvement in the diagnosis and treatment of heart failure

McCullough

Philbin

Spertus

et al. 2003

Clinical Cardiology

Self Cite

View full text Add to dashboard Cite

SummaryBackground: Improved treatment of congestive heart failure (CHF) can slow disease progression, promote clinical stability, and prolong survival.Hypothesis: Patterns in diagnostic test utilization and pharmacotherapy among patients with newly diagnosed heart failure may affect outcomes.Methods: Claims data were analyzed from all diagnostic procedures and prescriptions from 1995 to 1998 in 3,353 patients with heart failure diagnosed within 1 year. Rates of diagnostic testing and categories of drugs prescribed were the main outcome measures. Demographic variables and type of provider were analyzed within a setting whose access to care was controlled.Results: Rates of diagnostic testing with respect to basic, metabolic/endocrine, alternative diagnoses, underlying ischemia, and left ventricular function varied as a function of gender, age, race, and primary versus specialty care provider. Only 4.7% of patients underwent all diagnostics and treatments recommended in current guidelines. However, those patients (27.5%) who underwent an evaluation for ischemic heart disease and were prescribed vasodilators or beta blockers enjoyed the lowest crude mortality.

show abstract

Evaluating Quality of Care for Patients With Heart Failure

Cited by 143 publications

References 74 publications

Care and Outcomes of Patients Newly Hospitalized for Heart Failure in the Community Treated by Cardiologists Compared With Other Specialists

Care and Outcomes of Patients Newly Hospitalized for Heart Failure in the Community Treated by Cardiologists Compared With Other Specialists

2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults

Opportunities for improvement in the diagnosis and treatment of heart failure

Contact Info

Product

Resources

About