on May 28, 2008
Published online before print May 28, 2008, doi: 10.1161/CIRCHEARTFAILURE.108.772228
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Original Article |
Heart Failure Care in the Outpatient Cardiology Practice Setting: Findings from IMPROVE HF
1 Ahmanson-UCLA Cardiomyopathy Center;
2 Baylor University Medical Center;
3 Cleveland Clinic Foundation;
4 University of South Florida;
5 Campbell Univ. School of Pharmacy & Duke Univ. Medical Center;
6 Northwestern University Feinberg School of Medicine;
7 Scripps Clinic;
8 Outcome Sciences;
9 University of Maryland School of Medicine;
10 Duke University Medical Center;
11 Oklahoma University Health Science Center;
12 The Care Group
13 E-mail: gfonarow{at}mednet.ucla.edu
Background—Few data exist regarding contemporary care patterns for heart failure (HF)in the outpatient setting. IMPROVE HF is a prospective cohort study designed to characterize current management of patients with chronic HF and low ejection fraction(EF)
35% in a national registry of 167 US outpatient cardiology practices.
Methods and Results—Baseline patient characteristics and data on care of 15,381 patients with diagnosed HF or prior myocardial infarction and left ventricular dysfunction were collected by chart abstraction. To quantify use of therapies, 7 individual metrics[use of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB), beta-blocker, aldosterone antagonist, anticoagulation, implantable cardioverter defibrillator (ICD), cardiac resynchronization therapy (CRT), and HF education] and composite metrics were assessed. Care metrics include only patients documented to be eligible and without contraindications/intolerance. Among practices, 69% are nonteaching. Patients are 71% male, median age 70 years, median EF 25%. Use of ACEI/ARB (80%) and beta-blocker (86%) were relatively high in eligible patients in the outpatient cardiology setting; other metrics showed lower rates of use: aldosterone antagonist (36%), device therapy (ICD/CRT with defibrillator 51%; CRT 39%), and education (61%). A median 27% of patients received all HF therapies for which they were potentially eligible on the basis of chart documentation. Use of guideline recommended therapies by practices varied widely.
Conclusions—These data are among the first to assess treatment in the outpatient setting since the release of the latest national HF guidelines and demonstrate substantial variation among cardiology practices in the documented therapies provided to HF patients.
Key Words: heart failure • registries • outpatient • quality of care
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