650 Variation in Quality of Care Among Patients Hospitalized With Acute Heart Failure in an International Trial: Findings From ASCEND-HF

Abstract

BackgroundTranslation of evidence-based heart failure (HF) therapies to clinical practice is incomplete and may be subject to international variation. We compared key HF quality indicators in acute HF (AHF) patients enrolled in the international Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) trial.MethodsPatients were admitted to hospital for AHF and comprised 5 regions (North America n=3149, Latin America n=658, Asia-Pacific n=1744, Central Europe n=966 and Western Europe n=490). Quality indicators assessed at hospital discharge from the US-based Get With The Guidelines program were used, including: medications (ACEI/ARB, beta blockers, aldosterone inhibitors, hydralazine-nitrates, statin therapy and warfarin) for eligible patients, use (or planned use) of implantable intracardiac devices (ICD, CRT) for eligible patients and blood pressure control (<140/90 mmHg).Results7007 intent-to-treat AHF patients in 398 centres were enrolled. There was significant variation in conformity between different quality indicators, ranging from 0% to 89% (See Table). Of all potential performance opportunities, 24,807 of 39874 (62%) were met, with Central Europe highest at 68%, followed by North America (65%), Western Europe (63%), Latin America (59%) and Asia-Pacific (56%), P<0.0001.Tabled 1ConclusionQuality of care for patients hospitalized with AHF remains suboptimal even within a randomized clinical trial. Moreover, significant unexplained inter-regional variability in quality of care exists. Further study is required to understand and overcome the global barriers to delivery of optimal evidence-based care. BackgroundTranslation of evidence-based heart failure (HF) therapies to clinical practice is incomplete and may be subject to international variation. We compared key HF quality indicators in acute HF (AHF) patients enrolled in the international Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) trial. Translation of evidence-based heart failure (HF) therapies to clinical practice is incomplete and may be subject to international variation. We compared key HF quality indicators in acute HF (AHF) patients enrolled in the international Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) trial. MethodsPatients were admitted to hospital for AHF and comprised 5 regions (North America n=3149, Latin America n=658, Asia-Pacific n=1744, Central Europe n=966 and Western Europe n=490). Quality indicators assessed at hospital discharge from the US-based Get With The Guidelines program were used, including: medications (ACEI/ARB, beta blockers, aldosterone inhibitors, hydralazine-nitrates, statin therapy and warfarin) for eligible patients, use (or planned use) of implantable intracardiac devices (ICD, CRT) for eligible patients and blood pressure control (<140/90 mmHg). Patients were admitted to hospital for AHF and comprised 5 regions (North America n=3149, Latin America n=658, Asia-Pacific n=1744, Central Europe n=966 and Western Europe n=490). Quality indicators assessed at hospital discharge from the US-based Get With The Guidelines program were used, including: medications (ACEI/ARB, beta blockers, aldosterone inhibitors, hydralazine-nitrates, statin therapy and warfarin) for eligible patients, use (or planned use) of implantable intracardiac devices (ICD, CRT) for eligible patients and blood pressure control (<140/90 mmHg). Results7007 intent-to-treat AHF patients in 398 centres were enrolled. There was significant variation in conformity between different quality indicators, ranging from 0% to 89% (See Table). Of all potential performance opportunities, 24,807 of 39874 (62%) were met, with Central Europe highest at 68%, followed by North America (65%), Western Europe (63%), Latin America (59%) and Asia-Pacific (56%), P<0.0001.Tabled 1 7007 intent-to-treat AHF patients in 398 centres were enrolled. There was significant variation in conformity between different quality indicators, ranging from 0% to 89% (See Table). Of all potential performance opportunities, 24,807 of 39874 (62%) were met, with Central Europe highest at 68%, followed by North America (65%), Western Europe (63%), Latin America (59%) and Asia-Pacific (56%), P<0.0001. ConclusionQuality of care for patients hospitalized with AHF remains suboptimal even within a randomized clinical trial. Moreover, significant unexplained inter-regional variability in quality of care exists. Further study is required to understand and overcome the global barriers to delivery of optimal evidence-based care. Quality of care for patients hospitalized with AHF remains suboptimal even within a randomized clinical trial. Moreover, significant unexplained inter-regional variability in quality of care exists. Further study is required to understand and overcome the global barriers to delivery of optimal evidence-based care.