ACC: Heart failure assessment varies across hospital type, location

SAN FRANCISCO—Measurement of left ventricular ejection fraction (LVEF) in hospitalized heart failure patients varies, with patients outside of hospitals with tertiary services at a disadvantage, according to a scientific poster presented March 10 at the American College of Cardiology (ACC) scientific session.

Measurement of LVEF in patients with hospitalized heart failure (HF) is a key performance indicator (KPI). Study co-author, Glen L. Sumner, MD, of Libin Cardiovascular Institute of Alberta in Canada and the department of cardiac sciences at the University of Calgary in Alberta, said that he and his colleagues were seeking to determine if measurement of adherence to this KPI varied by hospital type in Alberta’s urban and rural areas.

Jonathan Howlett, MD, of Alberta Health Services in Calgary, and colleagues used the Discharge Abstract Database in Alberta to identify a cohort of patients discharged alive between Jan. 1, 2010, and Dec. 31, 2010 with a primary diagnosis of heart failure. Any test for which a measure of LVEF may be reported was included, provided it was performed within the 12-month window beginning nine months prior to hospitalization to three months following discharge. Patients were excluded if they transferred hospitals, or did not have complete data or follow-up.

“We figured that three months after hospitalization was an appropriate time frame in which these patients should have followed up," said Sumner. “We could have given them a longer window, but deemed three months reasonable after hospitalizations.”

The researchers grouped patients into hospitals according to provision of tertiary cardiac services, and by type of attending physician.

The cohort comprised of 2,952 individuals (1,780 presenting to a tertiary facility and 1,172 to a non-tertiary facility), of which only 61 percent had LVEF assessment performed. Of those LVEF tests, 70 percent were performed by echocardiography, 25 percent with angiogram and 7 percent with a nuclear medicine exam.

“We are trying to increase the penetration of imaging to appropriately follow up with heart failure patients, particularly in the rural communities where there is a clear gap in care, based on our results,” Sumner said.

The researchers found that patients in tertiary care centers and with a cardiologist attending were most likely to undergo measurement of LVEF.

The tertiary care centers were located within Calgary, and the non-tertiary care centers in the study were located in rural areas outside Calgary, Sumner explained. Seventy percent of the tertiary care facilities measured LVEF within the designated time frame, while only 48 percent of the non-tertiary hospitals did.

Also, 48 percent were not measured when a general practitioner was attending, while only 20 percent were not measured with a cardiologist attending and 28 percent with an internist attending.

Based on their findings, Howlett and his colleagues concluded that further efforts to identify and address barriers to measurement of LVEF in patients with HF are needed, with a particular focus on strategies to enhance key measurement of LVEF in non-tertiary hospitals.

In fact, they are currently rolling electronic order sets through the EHR and mobile apps to better educate the non-tertiary care providers, according to Sumner.