This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (117)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Harlan M. Krumholz, MD; Yun Wang, MS; Eugene M. Parent, MD; Joyce Mockalis, RN; Marcia Petrillo, MA; Martha J. Radford, MD

Arch Intern Med. 1997;157(19):2242-2247.

Abstract
Background
There is increasing interest in the development of explicit criteria to evaluate the quality of care for patients with heart failure. However, despite this interest, there is a paucity of information about the care of these patients in actual clinical practice across diverse sites.

Methods
We conducted a retrospective medical record review across 9 acute care hospitals in Connecticut. We selected 200 random admissions from each hospital with a principal discharge diagnosis of heart failure in 1994. Hospitals with fewer than 200 cases had 100% of cases selected. Patients with heart failure secondary to severe aortic stenosis, mitral stenosis, or medical illness were excluded. We evaluated the percentage of patients receiving appropriate treatments and interventions as defined by quality-of-care indicators derived from the Agency for Health Care Policy and Research Clinical Practice Guidelines.

Results
Data were abstracted from 1623 hospitalizations and the presence of heart failure was validated by chart review in 1535 (95%). In cohorts of ideal candidates for specific interventions, 832 (75%) of 1110 had a left ventricular ejection fraction documented or measured; 346 (86%) of 401 received angiotensin-converting enzyme inhibitors; 38 (14%) of 271 received target doses of angiotensin-converting enzyme inhibitors; 1359 (97%) of 1400 had counseling about medications documented; 90 (6%) of 1400 had counseling about weight documented; 980 (70%) of 1400 had counseling about diet documented; 856 (61%) of 1400 had counseling about exercise and activity documented; and 14 (11%) of 128 smokers had counseling about cessation documented.

Conclusions
These data demonstrate that the documentation of left ventricular systolic function and counseling for diet, weight, activity, and smoking may provide the best opportunities to improve the hospital care of elderly patients with heart failure. The use of angiotensin-converting enzyme inhibitors in appropriate patients is relatively high, indicating successful translation of trial results into clinical practice at these hospitals.

Arch Intern Med. 1997;157:2242-2247

Author Affiliations
From the Section of Cardiovascular Medicine, Department of Medicine, and the Section of Chronic Disease Epidemiology, Department of Epidemiology and Public Health, Yale School of Medicine and the Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Conn (Drs Krumholz and Parent), the Connecticut Peer Review Organization, Middletown (Drs Krumholz and Radford, Mr Wang, and Mss Mockalis and Petrillo), and the Cardiology Division, Department of Medicine, University of Connecticut Medical School, Farmington (Dr Radford).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation
Hunt et al.
J Am Coll Cardiol 2009;53:e1-e90.
FULL TEXT  

2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the International Society for Heart and Lung Transplantation
2005 WRITING COMMITTEE MEMBERS et al.
Circulation 2009;119:e391-e479.
FULL TEXT  

Association of Patient Case-Mix Adjustment, Hospital Process Performance Rankings, and Eligibility for Financial Incentives
Mehta et al.
JAMA 2008;300:1897-1903.
ABSTRACT | FULL TEXT  

Hospital Discharge Education for Patients With Heart Failure: What Really Works and What Is the Evidence?
Paul
Crit Care Nurse 2008;28:66-82.
FULL TEXT  

A campaign to improve the timeliness of primary percutaneous coronary intervention: Door-to-Balloon: An Alliance for Quality.
Krumholz et al.
J Am Coll Cardiol Intv 2008;1:97-104.
ABSTRACT | FULL TEXT  

Effect of Content and Format of Prescription Drug Labels on Readability, Understanding, and Medication Use: A Systematic Review
Shrank et al.
The Annals of Pharmacotherapy 2007;41:783-801.
ABSTRACT | FULL TEXT  

Effect of discharge instructions on readmission of hospitalised patients with heart failure: do all of the Joint Commission on Accreditation of Healthcare Organizations heart failure core measures reflect better care?
VanSuch et al.
Qual Saf Health Care 2006;15:414-417.
ABSTRACT | FULL TEXT  

Outcome of heart failure with preserved ejection fraction in a population-based study.
Bhatia et al.
NEJM 2006;355:260-269.
ABSTRACT | FULL TEXT  

Mortality and Morbidity Remain High Despite Captopril and/or Valsartan Therapy in Elderly Patients With Left Ventricular Systolic Dysfunction, Heart Failure, or Both After Acute Myocardial Infarction: Results From the Valsartan in Acute Myocardial Infarction Trial (VALIANT)
White et al.
Circulation 2005;112:3391-3399.
ABSTRACT | FULL TEXT  

The Complexity and Cost of Drug Regimens of Older Patients Hospitalized With Heart Failure in the United States, 1998-2001
Masoudi et al.
Arch Intern Med 2005;165:2069-2076.
ABSTRACT | FULL TEXT  

Health care professionals in a heart failure team
Jaarsma
Eur J Heart Fail 2005;7:343-349.
ABSTRACT | FULL TEXT  

Comparison of treatment of patients with congestive heart failure by cardiologists versus noncardiologists
Patel and Fotis
Am J Health Syst Pharm 2005;62:168-172.
ABSTRACT | FULL TEXT  

Primary results of the Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT): A multicenter study of B-type natriuretic peptide levels, emergency department decision making, and outcomes in patients presenting with shortness of breath
Maisel et al.
J Am Coll Cardiol 2004;44:1328-1333.
ABSTRACT | FULL TEXT  

Documentation on Withdrawal of Life Support in Adult Patients in the Intensive Care Unit
Kirchhoff et al.
Am J Crit Care 2004;13:328-334.
ABSTRACT | FULL TEXT  

Outcomes and the quality of care for patients hospitalized with heart failure
Luthi et al.
Int J Qual Health Care 2004;16:201-210.
ABSTRACT | FULL TEXT  

Is readmission to hospital an indicator of poor process of care for patients with heart failure?
Luthi et al.
Qual Saf Health Care 2004;13:46-51.
ABSTRACT | FULL TEXT  

Readmissions and the quality of care in patients hospitalized with heart failure
Luthi et al.
Int J Qual Health Care 2003;15:413-421.
ABSTRACT | FULL TEXT  

Improving Guideline Adherence: A Randomized Trial Evaluating Strategies to Increase {beta}-Blocker Use in Heart Failure
Ansari et al.
Circulation 2003;107:2799-2804.
ABSTRACT | FULL TEXT  

Development of circulatory-renal limitations to angiotensin-converting enzyme inhibitors identifies patients with severe heart failure and early mortality
Kittleson et al.
J Am Coll Cardiol 2003;41:2029-2035.
ABSTRACT | FULL TEXT  

Elderly Hospitalized Patients With Diastolic Heart Failure: Lack of Gender and Ethnic Differences in 18-Month Mortality Rates
Ibrahim et al.
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2003;58:M56-59.
ABSTRACT | FULL TEXT  

Quality of Care for Patients Hospitalized With Heart Failure: Assessing the Impact of Hospitalists
Lindenauer et al.
Arch Intern Med 2002;162:1251-1256.
ABSTRACT | FULL TEXT  

Left Ventricular Ejection Fraction Test Rates for Medicare Beneficiaries With Heart Failure
Wu and Pope
American Journal of Medical Quality 2002;17:61-66.
ABSTRACT  

ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure)
Hunt et al.
Circulation 2001;104:2996-3007.
FULL TEXT  

ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary: A report of the american college of cardiology/american heart association task force on practice guidelines (committee to revise the 1995 guidelines for the evaluation and management of heart failure) developed in collaboration with the international society for heart and lung transplantation endorsed by the heart failure society of america
Hunt et al.
J Am Coll Cardiol 2001;38:2101-2113.
FULL TEXT  

Failing ageing hearts
Petrie et al.
Eur Heart J 2001;22:1978-1990.
 

Improving Care for Elderly Patients With Peptic Ulcer Disease: Should the Focus Be on Drugs or Bugs?
Butler et al.
JAMA 2001;286:2023-2024.
FULL TEXT  

Quality of congestive heart failure treatment at a Canadian teaching hospital
Weil and Tu
CMAJ 2001;165:284-287.
ABSTRACT | FULL TEXT  

Ambulatory heart failure management in private practice in France
Komajda et al.
Eur J Heart Fail 2001;3:503-507.
ABSTRACT | FULL TEXT  

Gaps and opportunities in the practice of medicine: the need for improved systems of care
Krumholz
Eur Heart J 2001;22:889-890.
 

Specialty-related differences in the epidemiology, clinical profile, management and outcome of patients hospitalized for heart failure. The OSCUR study
Bellotti et al.
Eur Heart J 2001;22:596-604.
ABSTRACT  

Heart Failure in the 21st Century: A Cardiogeriatric Syndrome
Rich
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2001;56:88M-96.
ABSTRACT | FULL TEXT  

New Zealand and United Kingdom experiences with the RAND modified Delphi approach to producing angina and heart failure criteria for quality assessment in general practice
Buetow and Coster
Qual Saf Health Care 2000;9:222-231.
ABSTRACT | FULL TEXT  

A national survey of heart failure in French hospitals
Cohen-Solal et al.
Eur Heart J 2000;21:763-769.
ABSTRACT  

Measuring and Improving Quality of Care : A Report From the American Heart Association/American College of Cardiology First Scientific Forum on Assessment of Healthcare Quality in Cardiovascular Disease and Stroke
Stroke 2000;31:1002-1012.
FULL TEXT  

Measuring and Improving Quality of Care : A Report From the American Heart Association/American College of Cardiology First Scientific Forum on Assessment of Healthcare Quality in Cardiovascular Disease and Stroke
Circulation 2000;101:1483-1493.
FULL TEXT  

Evaluating Quality of Care for Patients With Heart Failure
Krumholz et al.
Circulation 2000;101 :e122-e140.
FULL TEXT  

Assessing the Population Burden From Heart Failure: Need for Sentinel Population-Based Surveillance Systems
Goldberg and Konstam
Arch Intern Med 1999;159:15-17.
FULL TEXT  

Rates of Health Services Utilization and Survival in Patients with Heart Failure in the Department of Veterans Affairs Medical Care System
Ashton et al.
American Journal of Medical Quality 1999;14:55-63.
ABSTRACT  

Coming of Age
Boyer
Arch Intern Med 1997;157:2173-2173.
ABSTRACT