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Quality of Care for Secondary HF

Quality of Care for Secondary HF

Current performance measures for heart failure (HF) from CMS target patients with a principal diagnosis of the disease. HF performance measures include evaluating left ventricular (LV) systolic function and providing a discharge prescription for either ACE inhibitors or angiotensin receptor blockers (ARBs). The American College of Cardiology, American Heart Association, and the American Medical Association-Physician Consortium for Performance Improvement have endorsed similar guidelines for adult HF care. Assessing Hospitalizations A study published in the Journal of the American College of Cardiology assessed the quality of care for HF patients who were hospitalized for all causes. Lead researcher Saul B. Blecker, MD, MHS, and colleagues assessed rates of compliance with care measures for 4,345 patients hospitalized with acute or chronic HF. “The majority of hospitalizations for individuals with HF had a principal diagnosis that was not HF,” says Dr. Blecker. Only 39.6% of patients had a primary diagnosis of HF.   The investigation also showed that, when compared with HF patients hospitalized for another primary indication, those with a primary HF diagnosis had higher rates of receiving guideline-recommended care, including evaluation of LV systolic function and higher rates of ACE inhibitor or ARB discharge prescriptions. HF patients assessed for LV systolic function had a 34% lower mortality rate in the year following discharge when compared with those who did not receive this evaluation. Prescription of ACE inhibitors or ARBs at discharge for patients with LV systolic dysfunction was associated with a 28% reduced 1-year mortality risk. “The quality of care for hospitalized HF patients could be dramatically improved by extending the same standards of care to patients with both a...
Examining Trends in HF Hospitalizations

Examining Trends in HF Hospitalizations

According to recent estimates, heart failure (HF) is one of the most common reasons for hospital admission in the United States. Efforts have been made to reduce the number of hospitalizations related to HF, and several therapies have been developed over the last 20 years that have been shown to reduce disease-related hospitalizations. Furthermore, quality improvement initiatives are being developed and launched to ensure the appropriate delivery of evidence-based therapies in HF. CMS has been reporting on the quality of care and rate of HF rehospitalization for hospitals in an effort to encourage quality improvement initiatives. “While previous analyses have shown that rates of HF hospitalizations increased in the 1980s and 1990s, more recent CMS data indicate that hospitalizations with a primary diagnosis of HF in the elderly declined over the last decade,” explains Saul B. Blecker, MD, MHS. “These findings have been attributed to improvements in treatment and reductions in prevalent HF. However, most hospitalizations involving these patients are for reasons other than acute HF.” Gaining Perspective on Secondary HF Hospitalizations Quality improvement initiatives typically target only hospitalizations with a primary diagnosis of HF. As a result, these initiatives may not affect comorbid conditions that are associated with HF but are not directly caused by it. “Characterizing trends in hospitalizations with HF as a primary or secondary diagnosis can help clinicians further understand and recognize the role of cardiac disease and non-cardiac conditions,” Dr. Blecker says. “It can also help educate future initiatives to improve quality improvement initiatives.” A study by Dr. Blecker and colleagues published in the Journal of the American College of Cardiology evaluated trends in...
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