This Article  • 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 (54)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Treatment Adherence  • Cardiovascular System  • Quality of Care, Other  • Congestive Heart Failure/ Cardiomyopathy  • Alert me on articles by topic  Social Bookmarking   What's this?

Analysis of the ADHERE Registry

Gregg C. Fonarow, MD; Clyde W. Yancy, MD; J. Thomas Heywood, MD; for the ADHERE Scientific Advisory Committee, Study Group, and Investigators

Arch Intern Med. 2005;165:1469-1477.

Background  Quality-of-care indicators have been developed for patients hospitalized with heart failure. However, little is known about current rates of conformity with these indicators or their variability across hospitals.

Methods  Data from 81 142 admissions occurring between July 1, 2002, and December 31, 2003, at 223 academic and nonacademic hospitals in the United States participating in the Acute Decompensated Heart Failure National Registry (ADHERE) were analyzed. Rates of conformity with the 4 Joint Commission on Accreditation of Healthcare Organizations core performance measures—discharge instructions (HF-1), assessment of left ventricular function (HF-2), use of angiotensin-converting enzyme inhibitors in patients with left ventricular systolic dysfunction (HF-3), and smoking cessation counseling (HF-4)—as well as length of stay and in-hospital mortality rates were computed.

Results  Across all hospitals, the median rates of conformity with HF-1, HF-2, HF-3, and HF-4 were 24.0%, 86.2%, 72.0%, and 43.2%, respectively. Rates of conformity at individual hospitals varied from 0% to 100%, with statistically significant differences between academic and nonacademic hospitals. Statistically significant positive independent predictors of overall conformity included the prevalence of comorbidities and the use of more intense pharmacologic management. Median hospital length of stay varied from 2.3 to 9.5 days, and in-hospital mortality varied from 0% to 11.1%.

Conclusions  Among hospitals providing care for patients with heart failure, there is significant individual variability in conformity to quality-of-care indicators and clinical outcomes and a substantial gap in overall performance. Establishing educational initiatives and quality improvement systems to reduce this variability and eliminate this gap would be expected to substantially improve the care of these patients.

Author Affiliations: Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, The David Geffen School of Medicine at the University of California, Los Angeles (Dr Fonarow); Division of Cardiology, The University of Texas Southwestern Medical Center, Dallas (Dr Yancy); and Loma Linda University Medical Center, Loma Linda, Calif (Dr Heywood).
Group Information: A list of hospitals participating in ADHERE can be found at http://www.adhereregistry.com.

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

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Effectiveness of Public Report Cards for Improving the Quality of Cardiac Care: The EFFECT Study: A Randomized Trial
Tu et al.
JAMA 2009;0:2009.1731-8.
ABSTRACT | FULL TEXT  

Reduced in-hospital mortality for heart failure with clinical pathways: the results of a cluster randomised controlled trial
Panella et al.
Qual Saf Health Care 2009;18:369-373.
ABSTRACT | FULL TEXT  

State of the Science: Promoting Self-Care in Persons With Heart Failure: A Scientific Statement From the American Heart Association
Riegel et al.
Circulation 2009;120:1141-1163.
FULL TEXT  

Heart Failure Performance Measures and Outcomes: Real or Illusory Gains
Fonarow and Peterson
JAMA 2009;302:792-794.
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
Hunt et al.
J Am Coll Cardiol 2009;53:e1-e90.
FULL TEXT  

2009 Focused Update: ACCF/AHA 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
Jessup et al.
J Am Coll Cardiol 2009;53:1343-1382.
FULL TEXT  

2009 Focused Update: ACCF/AHA 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
2009 WRITING GROUP TO REVIEW NEW EVIDENCE AND UPDA et al.
Circulation 2009;119:1977-2016.
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  

Acute heart failure syndromes.
Gheorghiade and Pang
J Am Coll Cardiol 2009;53:557-573.
ABSTRACT | FULL TEXT  

Measuring Quality in Heart Failure: Do We Have the Metrics?
Bonow
Circ Cardiovasc Qual Outcomes 2008;1:9-11.
FULL TEXT  

Translating Research Into Practice for Healthcare Providers: The American Heart Association's Strategy for Building Healthier Lives, Free of Cardiovascular Diseases and Stroke
Jones et al.
Circulation 2008;118:687-696.
ABSTRACT | FULL TEXT  

Therapeutic Strategies in Heart Failure
Givertz
Circulation 2008;118:e76-e77.
FULL TEXT  

Heart Failure Care in the Outpatient Cardiology Practice Setting: Findings From IMPROVE HF
Fonarow et al.
Circ Heart Fail 2008;1:98-106.
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  

Impact of Treatment Guidelines on Clinical and Economic Outcomes of Acute Decompensated Heart Failure
DiDomenico et al.
The Annals of Pharmacotherapy 2008;42:327-333.
ABSTRACT | FULL TEXT  

Association Between Performance Measures and Clinical Outcomes for Patients Hospitalized With Heart Failure
Fonarow et al.
JAMA 2007;297:61-70.
ABSTRACT | FULL TEXT  

The Year in Heart Failure
Tang and Francis
J Am Coll Cardiol 2006;48:2575-2583.
FULL TEXT  

Compliance by Referring Physicians With Recommendations on Heart Failure Therapy from a Tertiary Center
Rocca et al.
J CARDIOVASC PHARMACOL THER 2006;11:85-92.
ABSTRACT  

Digoxin and reduction in mortality and hospitalization in heart failure: a comprehensive post hoc analysis of the DIG trial
Ahmed et al.
Eur Heart J 2006;27:178-186.
ABSTRACT | FULL TEXT  

The Year in Heart Failure
Tang and Francis
J Am Coll Cardiol 2005;46:2125-2133.
FULL TEXT  

Quality: The Need for Intelligent Efforts
Baruch and Phillips
Arch Intern Med 2005;165:1455-1456.
FULL TEXT