Abstract
Background: Variations between outpatient cardiology practices in adherence to guideline-recommended therapies for heart failure (HF) have previously been described. The effect of performance improvement initiatives on reducing these variations has not been evaluated. Methods: IMPROVE HF is a prospective evaluation of a practice-based, performance improvement intervention implemented at cardiology practices to increase use of evidence-based, guideline-recommended care for eligible outpatients with systolic HF or post-myocardial infarction LVSD. Variations in use of 7 individual and 2 summary care measures were assessed by comparing the 10 th and 90 th percentiles, the inter-decile differences, and variance for each measure at baseline (pre-intervention) and 24 months post-intervention. Results: A total of 15,177 patients followed in 155 of 167 practices were available for analysis. Substantial variations for all care measures were evident at baseline with inter-decile differences ranging from 23.6% for β-blockers to 81.3% for CRT-P/CRT-D. The 24-month evaluation revealed significant improvements in adherence to 6 of 7 specific measures, the composite, and all-or-none care measures. However, large care variations persisted among practices with interdecile differences at 24 months ranging from 16.2% to 75.0%. No measure demonstrated significantly reduced variation at 24 months compared to baseline. Conclusions: Implementation of a practice-based performance improvement initiative resulted in substantial improvement in adherence to guideline-recommended therapies for HF. However, wide variations in provision of evidence-based care persisted among cardiology practices. Additional targeted interventions may be necessary to reduce variations in use of guideline-recommended HF therapies in outpatient cardiology practices.
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