July 27, 2010 – Results of the largest U.S. outpatient heart failure clinical study show that implementation of a process improvement program significantly improved adherence to evidence-based, guideline-recommended cardiac resynchronization therapy (CRT), implantable cardioverter-defibrillator (ICD) and drug therapy. Twenty-four-month findings from IMPROVE HF, (The Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting), will be published in the Aug. 10 issue of the journal Circulation.
The study demonstrates that cardiology practices implementing the process improvement program significantly increased use on five of seven guideline-recommended care measures. Specifically, CRT and ICD use increased by 30 and 27 percent, respectively, and aldosterone antagonist use increased by 25 percent, all compared to baseline results. The study also showed significant improvement on use of beta-blockers and the delivery of heart failure education when practice improvement programs were implemented. Use of angiotensin converting enzyme inhibitors or angiotensin II receptor blockers and anticoagulation for atrial fibrillation did not show significant improvement.
“With more than 5 million Americans suffering from heart failure and as one of the few cardiovascular diseases on the rise, there is a clear and urgent need to close the treatment gap between heart failure guidelines and the level of care patients currently receive,” said Gregg C. Fonarow, M.D., co-chair of the IMPROVE HF Scientific Steering Committee and professor of cardiovascular medicine at the University of California at Los Angeles. “The IMPROVE HF study results serve as a call to action to transform heart failure care delivery in the outpatient practice setting to consistently implement guideline-driven standards of care.”
IMPROVE HF baseline data, collected prior to any performance improvement intervention, demonstrated inconsistencies in guideline recommended care for heart failure patients, with women and elderly particularly at risk for underutilization of lifesaving heart failure device therapies. Specifically, clinic-level analysis shows only 37 percent of eligible heart failure patients received a CRT device, 50 percent received an ICD, and 35 percent received aldosterone antagonist drug therapy. The 24-month data, which were gathered after implementing the practice-specific performance improvement interventions, showed higher utilization with CRT therapy increasing to 66 percent, ICD use increasing to 78 percent and aldosterone antagonist drug therapy increasing to 60 percent utilization.
IMPROVE HF is the first-of-its-kind, large-scale, prospective study involving approximately 35,000 heart failure patients from 167 U.S. cardiology practices. Using a process improvement intervention and chart reviews at baseline, six, 12, 18 and 24 months, IMPROVE HF was designed to quantify and improve quality of care for heart failure patients by promoting the use of evidence-based, guideline-recommended therapies. All study data were collected and analyzed by an independent clinical research organization.
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