Circulation: Most evidence-based strategies can IMPROVE HF

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Five of the seven evidence-based strategies within the IMPROVE HF program improved heart failure (HF) care in cardiology practices, according to a study published online July 26 in Circulation.

The five successful intervention measures included beta blocker usage, administering aldosterone antagonist medication, cardiac resynchronization therapy (CRT), use of implantable cardioverter-defibrillator (ICD) devices and HF patient education.

“Although several programs have helped improve heart failure patient care in the hospital, this is the largest performance improvement intervention on the use of national guideline-recommended therapies in an outpatient clinic setting,” the authors wrote.

Gregg Fonarow, MD, from the University of California, Los Angeles, and colleagues assessed the use of the IMPROVE HF (Registry to Improve the Uses of Evidence-Based Heart Failure therapies in the Outpatient Setting) program in 34,810 patients diagnosed with MI, weakened left ventricular function or chronic HF at 167 cardiology practice clinics in the U.S.

The IMPROVE HF program utilized tool kits that included checklists, education outreach measures and performance profiling to help ensure that care for HF patients reaches the seven care treatments that are recommended and developed by the American College of Cardiology (ACC) and the American Heart Association (AHA).

After implementing the IMPROVE HF program, the researchers found that use of the five aforementioned intervention measures, increased significantly.

From baseline to post intervention the researchers found that:

  • Beta blocker use increased from 86 percent to 92.2 percent;
  • Aldosterone antagonist medication rose 34.5 percent to 60.3 percent;
  • CRT use increased from 37.2 percent to 66.3 percent;
  • ICD device use rose from 50.1 percent to 77.5 percent; and
  • Education for HF patients rose from 59.5 to 72.1 percent.

"We found substantial, clinically relevant improvement in the number of heart failure patients receiving key treatments after introducing this new performance improvement intervention program at the participating cardiology practices," said Fonarow.

The researchers found that the opportunity to utilize national guideline-recommended therapies for HF patients increased from 68.4 percent to 80.1 percent two years after initiation of the IMPROVE HF programs.

However, for two of the seven interventions, use of angiotensin-converting enzyme inhibitor/angiotensin receptor blockers and use of anticoagulants to treat atrial fibrillation, there were no significant improvements.

“Further study is needed to explore why usage of these two treatments did not improve,” the authors wrote.

Due to the significant improvements reported, the authors said that this study represented evidence that the program, or others like it, should be implemented across the U.S.

"This study suggests that receipt of patient-level performance feedback that is actionable appears to be a particularly important component of heart failure performance improvement efforts. Because IMPROVE HF, with the exception of the practice-specific data collection, utilized existing personnel and resources within each practice, it may be more scalable and sustainable than alternative models to improve outpatient cardiovascular care,” Fonarow concluded.