Four of five hospital performance measures for heart failure do not appear to accurately reflect the quality of care provided, according to a study in the January 3 issue of JAMA.
Heart failure continues to be a serious public health concern in the United States: the overall prevalence of heart failure was 5 million individuals in 2003, with 550,000 new cases being reported each year. Heart failure is the leading cause of hospitalization in persons older than 65 years, with almost 3.6 million hospitalizations attributed to heart failure as the primary or a secondary discharge diagnosis each year, according to background information in the article. Because heart failure is a substantial cause of illness, death, and health care expenditures, it is important to use evidence-based therapies that have been shown to improve clinical outcomes.
The American College of Cardiology and the American Heart Association (ACC/AHA) have developed clinical practice guidelines outlining diagnostic and therapeutic interventions for patients with heart failure. Adherence to these suggested interventions may serve as a marker of quality of care and form a foundation for quality improvement. Heart failure performance measures have been developed to provide a mechanism through which the quality of medical care can be measured and improved. The recently released ACC/AHA Clinical Performance Measures for Adults With Chronic Heart Failure includes: discharge instructions, evaluation of left ventricular systolic function, angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) for left ventricular systolic dysfunction (LVSD), adult smoking cessation advice/counseling, and anticoagulant at discharge for patients with atrial fibrillation. Although it is expected that application of these carefully developed heart failure inpatient performance measures should result in substantial improvement in heart failure patient outcomes, available data valida
Contact: Waddell Albin
JAMA and Archives Journals