Predictors of Delivery of Hospital-Based Heart Failure Patient Education: A Report from OPTIMIZE-HF

Abstract

Although recent heart failure (HF) management guidelines recommend delivery of patient education and discharge instructions, little is known about predictors of delivery of these materials or how such materials relate to outpatient disposition postdischarge. This report assesses the degree to which the full set of HF discharge instructions and education comprising the Joint Commission on Accreditation of Healthcare Organizations process-of-care measure (HF-1) was provided, identifies factors predictive of use of HF-1, and determines if HF-1 predicts postdischarge outcome disposition in a registry and performance improvement (PI) program for patients hospitalized for HF. In the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (ie, OPTIMIZE-HF), of 33,681 patients from 259 US hospitals, 54% received HF-1. Some patient and site characteristics, such as symptoms on admission and performance of coronary angiography, were positively associated with delivery of the full set of HF-1 components, and others, such as African-American or Hispanic race and Midwest site location, were negatively associated with HF-1 delivery. However, delivery of the full set of HF-1 components was significantly more likely in the 46% of patients receiving PI tools (OR 2.23, 95% CI 2.12-2.35; P < .0001). Delivery of the full set of HF-1 components was significantly associated with use of specialty referral programs after discharge (P < .0001). Despite recommendations that complete instructions be given to patients with HF before hospital discharge, both PI tools to facilitate HF-1 and HF-1 itself are underused. Efforts should focus on strengthening processes and structures that will improve consistent delivery of HF-1 to all patients.