Performance Measures for Patients Hospitalized With Heart Failure: Are They Predictive of Clinical Outcomes?

Abstract

Assessment of quality of care in heart failure (HF) has focused on the development and use of process of care-based performance measures. While it has been presumed that these process measures when applied in actual clinical practice are associated with improved clinical outcomes, this link has not been well-established. A recent analysis of the Organized Program to Initiate Lifesaving Treatment In Hospitalized Patients With Heart Failure (OPTIMIZE-HF) 1 registry/performance improvement program examined the relationship between current performance measures for patients hospitalized with HF and relevant patient clinical outcomes. This study found that none of the current HF performance measures were significantly associated with reduced early mortality risk and only angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use at discharge was associated with 60- to 90-day postdischarge mortality or rehospitalization. b-Blocker therapy at the time of hospital discharge, currently not an HF performance measure, was strongly associated with reduced risk of mortality and mortality/rehospitalization postdischarge. To accurately identify health care providers and hospitals providing care that is associated with more optimal clinical outcomes, additional HF performance measures as well as better methodology for identifying and validating performance measures is needed. HF is the leading cause of hospitalization in persons older than 65 years, with almost 3.6 million hospitalizations attributed to HF as the primary or a secondary discharge diagnosis each year. 2 HF patients are at substantial risk for recurrent exacerbations of symptoms requiring intervention, with up to 50% of discharged patients being rehospitalized within 6 months. An estimated 11.6% of HF patients die within 30 days and 33.1% of patients die within 1 year after their first hospitalization for HF. 3 Uniform highquality health care might reasonably be expected to reduce this burden of morbidity and mortality associated with HF. Evidence-based guidelines for the diagnosis and treatment of patients with HF have been developed. 2,4 To facilitate the measurement of and improvement in quality of care in HF, components of these guidelines have been adapted by the various organizations as performance measures. 5,6 These performance measures are based on clinical practice guidelines but are intended to be confined to those structural aspects or processes of care for which the evidence is so strong that the failure to perform them reduces the likelihood of optimal patient outcomes. 5 It is impor