Better Heart Failure Measures Needed

 

January 3, 2007

Heartwire cites results of a new study finding that current heart-failure performance measures, with the exception of the prescription of an ACE inhibitor or angiotensin receptor blocker (ARB) at discharge, have little relationship to patient mortality or combined mortality/rehospitalization in the first 60 to 90 days after discharge.

And though not one of the measures of performance, the prescription of beta blockers at discharge was associated with the most significant improvement in heart-failure outcomes.

Investigators of the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry, say that the results suggest that additional measures, as well as better methods for identifying and validating heart-failure performance measures, are needed.

"The performance measures are publicly reported and are being used as criteria for pay-for-performance, for both hospitals and physicians receiving higher reimbursement," lead investigator Dr. Gregg Fonarow (University of California, Los Angeles Medical Center) told heartwire. "It is critical then that these measures are reflective of improved patient outcomes."

The ACC and AHA Clinical Performance Measures for Adults with Heart Failure includes the following components: discharge instructions, evaluation of left ventricular systolic function, ACE inhibitor or ARB for left ventricular systolic dysfunction, smoking-cessation counseling, and anticoagulant prescription for patients with atrial fibrillation.

Dr. Fonarow’s study is published in the Journal of the American Medical Association, 297:61-70.