Quality Of Heart Failure Care Research Articles

Geographic Variation in the Quality of Heart Failure Care Among U.S. Veterans

BackgroundThe burden of heart failure is growing. Guideline-directed medical therapies (GDMT) reduce adverse outcomes in heart failure with reduced ejection fraction (HFrEF). Whether there is geographic variation in HFrEF quality of care is not well described. ObjectivesThis study evaluated variation nationally for prescription of GDMT within the Veterans Health Administration. MethodsA cohort of Veterans with HFrEF had their address linked to hospital referral regions (HRRs). GDMT prescription was defined using pharmacy data between July 1, 2020, and July 1, 2021. Within HRRs, we calculated the percentage of Veterans prescribed GDMT and a composite GDMT z-score. National choropleth maps were created to evaluate prescription variation. Associations between GDMT performance and demographic characteristics were evaluated using linear regression. ResultsMaps demonstrated significant variation in the HRR composite score and GDMT prescriptions. Within HRRs, the prescription of beta-blockers to Veterans was highest with a median of 80% (IQR: 77.3%-82.2%) followed by angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitors (69.3%; IQR: 66.4%-72.1%), sodium-glucose cotransporter-2 inhibitors (10.3%; IQR: 7.7%-12.8%), mineralocorticoid receptor antagonists (29.2%; IQR: 25.8%-33.9%), and angiotensin receptor-neprilysin inhibitors (12.2%; IQR: 8.6%-15.3%). HRR composite GDMT z-scores were inversely associated with the HRR median Gini coefficient (R = −0.13; P = 0.0218) and the percentage of low-income residents (R = −0.117; P = 0.0413). ConclusionsWide geographic differences exist for HFrEF care. Targeted strategies may be required to increase GDMT prescription for Veterans in lower-performing regions, including those affected by income inequality and poverty.

Quality of Care and Clinical Outcomes for Patients With Heart Failure at Hospitals Caring for a High Proportion of Black Adults

Black adults with heart failure (HF) disproportionately experience higher population-level mortality than White adults with HF. Whether quality of care for HF differs at hospitals with high proportions of Black patients compared with other hospitals is unknown. To compare quality and outcomes for patients with HF at hospitals with high proportions of Black patients vs other hospitals. Patients hospitalized for HF at Get With The Guidelines (GWTG) HF sites from January 1, 2016, through December 1, 2019. These data were analyzed from May 2022 through November 2022. Hospitals caring for high proportions of Black patients. Quality of HF care based on 14 evidence-based measures, overall defect-free HF care, and 30-day readmissions and mortality in Medicare patients. This study included 422 483 patients (224 270 male [53.1%] and 284 618 White [67.4%]) with a mean age of 73.0 years. Among 480 hospitals participating in GWTG-HF, 96 were classified as hospitals with high proportions of Black patients. Quality of care was similar between hospitals with high proportions of Black patients compared with other hospitals for 11 of 14 GWTG-HF measures, including use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker/angiotensin receptor neprilysin inhibitors for left ventricle systolic dysfunction (high-proportion Black hospitals: 92.7% vs other hospitals: 92.4%; adjusted odds ratio [OR], 0.91; 95% CI, 0.65-1.27), evidence-based β-blockers (94.7% vs 93.7%; OR, 1.02; 95% CI, 0.82-1.28), angiotensin receptor neprilysin inhibitors at discharge (14.3% vs 16.8%; OR, 0.74; 95% CI, 0.54-1.02), anticoagulation for atrial fibrillation/flutter (88.8% vs 87.5%; OR, 1.05; 95% CI, 0.76-1.45), and implantable cardioverter-defibrillator counseling/placement/prescription at discharge (70.9% vs 71.0%; OR, 0.75; 95% CI, 0.50-1.13). Patients at high-proportion Black hospitals were less likely to be discharged with a follow-up visit made within 7 days or less (70.4% vs 80.1%; OR, 0.68; 95% CI, 0.53-0.86), receive cardiac resynchronization device placement/prescription (50.6% vs 53.8%; OR, 0.63; 95% CI, 0.42-0.95), or an aldosterone antagonist (50.4% vs 53.5%; OR, 0.69; 95% CI, 0.50-0.97). Overall defect-free HF care was similar between both groups of hospitals (82.6% vs 83.4%; OR, 0.89; 95% CI, 0.67-1.19) and there were no significant within-hospital differences in quality for Black patients vs White patients. Among Medicare beneficiaries, the risk-adjusted hazard ratio (HR) for 30-day readmissions was higher at high-proportion Black vs other hospitals (HR, 1.14; 95% CI, 1.02-1.26), but similar for 30-day mortality (HR 0.92; 95% CI,0.84-1.02). Quality of care for HF was similar across 11 of 14 measures at hospitals caring for high proportions of Black patients compared with other hospitals, as was overall defect-free HF care. There were no significant within-hospital differences in quality for Black patients vs White patients.

Abstract 10679: Do Hospitals Caring for a High Proportion of Black Adults Deliver Lower Quality Care for Heart Failure? An Analysis of the Get With the Guidelines-Heart Failure Registry

Introduction: Black individuals have higher hospitalization and mortality rates from heart failure (HF). Black adults receive care at a limited set of US hospitals (minority-serving hospitals [MSH]) and understanding quality of care at these sites could inform efforts to improve health equity. Using the Get With The Guidelines (GWTG) - HF Registry, we compared HF care quality and clinical outcomes at MSH vs. non-MSH. Methods: We identified adults ≥18 years hospitalized for HF at GWTG-HF sites. MSH were defined as the top quintile of proportion of hospitalizations for Black adults. We compared performance on GWTG-HF quality measures at MSH vs. non-MSH, adjusting for age, sex, comorbidities, and hospital characteristics, using GEE to account for clustering within sites. After restricting to adults ≥65 years and linking to Medicare FFS claims, we used multivariable Cox proportional hazard models to compare post-discharge outcomes. Results: Study population included 422,483 hospitalizations at 480 hospitals, of which 96 (with >38% Black patients) were MSH. Care quality was similar between MSHs and non-MSHs for 10 of 13 GWTG-HF measures; MSH patients were less likely to be discharged with 7-day follow up, CRT device planning, or aldosterone antagonist (Figure). Overall defect-free care was similar across sites; there were no within-hospital disparities between Black vs. White patients at both MSH and non-MSH. Among 111,930 Medicare beneficiaries, risk-adjusted 30-day readmissions were higher at MSH compared with non-MSH (HR 1.14, 95% CI 1.02-1.26), but risk-adjusted 30-day mortality was similar (HR 0.92, 95% CI 0.84-1.02). Conclusions: Across GWTG-HF-participating hospitals, HF care quality and mortality were similar at MSH vs. non-MSH, but MSH 30-day readmissions were higher. Improving MSH post-discharge follow-up could improve equity in HF outcomes, though additional investigation to address higher MSH readmissions is needed.

Abstract 12733: Understanding the Care Priorities of Older Patients With Heart Failure

Introduction: The average age of a Medicare beneficiary with heart failure (HF) is now 80 years old. As patients age, their care priorities may change. At present, “high quality” HF care is determined by the use of appropriate medications to forestall or reverse disease progression. The aim of this study to identify other care priorities among older adults with HF that should be considered when measuring the quality of HF care. Methods: We conducted semi-structured interviews with 41 patients ≥75 years old with HF. The oldest was 93 years old and the youngest was 75 with an average age of 82. Interviews were conducted in both the inpatient (n=23) and outpatient/clinic (n=18) settings. Patients were asked a series of 10 questions focused on care priorities and the characteristics of “high quality” care. Interviews were recorded and transcribed. The longest interview was 19:59 minutes, the shortest was 4:20 minutes and the average was 10:32 minutes. Recordings were listened to while reviewing the transcripts, then analyzed and coded for thematic analysis. Results: The domains of high quality care highlighted by older patients are described in Figure 1. The most important aspects of HF care included: “getting the right medicine” and “making me comfortable as long as I can be.” Patients defined high quality care as: “a team that listens” and “follows up.” A high quality provider was distinguished from a low quality provider by “honesty,” “compassion” and “the ability to listen.” When asked how providers/teams should be evaluated, patients recommended metrics that captured: “knowledge,” “communication” and “really caring.” Discussion: Current HF quality metrics capture less than half of the care domains that are important to older patients with HF. Additional work is needed to create novel quality metrics to incentivize all domains of high quality HF care.

Association between heart failure quality of care and mortality: a population-based cohort study using nationwide registries.

To evaluate the quality of heart failure (HF) care using the European Society of Cardiology (ESC) quality indicators (QIs) for HF and to assess whether better quality of care is associated with improved outcomes. We performed a nationwide cohort study using the Swedish HF registry, consisting of patients with any type of HF at their first outpatient visit or hospitalization. Independent participant data for quality of HF care was evaluated against the ESC QIs for HF, and association with mortality estimated using multivariable Cox regression. In total, 43 704 patients from 80 hospitals across Sweden enrolled between 2013-2019 were included, with median follow-up 23.6 months. Of the 16 QIs for HF, 13 could be measured and 5 were inversely associated with all-cause mortality during follow-up. Higher attainment (≥50% vs. <50% attainment) of the composite opportunity-based score (combination of QIs into a single score) for patients with reduced ejection fraction was associated with lower all-cause mortality (adjusted hazard ratio 0.81; 95% confidence interval 0.72-0.91). Attainment of the composite score was less in the outpatient than inpatient setting (adjusted odds ratio 0.85; 95% confidence interval 0.72-0.99). Quality of care varied across hospitals, with assessment of health-related quality of life being the indicator with the widest variation in attainment (interquartile range 61.7%). Quality of HF care may be measured using the ESC HF QIs. In Sweden, attainment of HF care evaluated using the QIs demonstrated between and within hospital variation, and many QIs were inversely associated with mortality.

Quality of care and risk of incident atrial fibrillation in patients with newly diagnosed heart failure: a nationwide cohort study.

Incident atrial fibrillation (AF) is an adverse prognostic indicator in heart failure (HF); identifying modifiable targets may be relevant to reduce the incidence and morbidity of AF. Therefore, we examined the association between quality of HF care and risk of AF. Using the Danish Heart Failure Registry, we conducted a nationwide registry-based cohort study of all incident HF patients diagnosed between 2008 and 2018 and without history of AF. Quality of HF care was assessed by seven process performance measures, including echocardiographic examination, New York Heart Association classification, treatment with angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, beta-blockers, and mineralocorticoid antagonists, physical training, and patient education. In the main analysis, we examined adherence with all measures in a cohort of 25 100 patients (mean age 68.5 ± 13.2 years; 33.6% women). The median follow-up was 3.1 years. Cox proportional hazard regressions estimated the hazard ratios (HRs) with 95% confidence intervals (95% CIs) between the number of fulfilled measures and incident AF. In a multivariable-adjusted analysis with 0 fulfilled performance measures as reference, the HRs (95% CIs) were 1: 0.78 (0.61-1.00), 2: 0.63 (0.49-0.80), 3: 0.53 (0.36-0.80), 4: 0.64 (0.44-0.94), 5: 0.56 (0.39-0.82), 6: 0.51 (0.35-0.74), and 7: 0.49 (0.33-0.73), with a significant decreasing linear trend (P < 0.001). In patients with incident HF, fulfilment of guideline-based process performance measures was associated with decreased long-term risk of AF. This study supports initiatives to improve the quality of care for patients with HF to prevent incident AF.

Frequency, trends and institutional variation in 30‐day all‐cause mortality and unplanned readmissions following hospitalisation for heart failure in Australia and New Zealand

National 30-day mortality and readmission rates after heart failure (HF) hospitalisations are a focus of US policy intervention and yet have rarely been assessed in other comparable countries. We examined the frequency, trends and institutional variation in 30-day mortality and unplanned readmission rates after HF hospitalisations in Australia and New Zealand. We included patients >18 years hospitalised with HF at all public and most private hospitals from 2010-15. The primary outcomes were the frequencies of 30-day mortality and unplanned readmissions, and the institutional risk-standardised mortality rate (RSMR) and readmission rate (RSRR) evaluated using separate cohorts. The mortality cohort included 153 592 patients (mean age 78.9 ± 11.8 years, 51.5% male) with 16 442 (10.7%) deaths within 30 days. The readmission cohort included 148 704 patients (mean age 78.6± 11.9 years, 51.7% male) with 33 158 (22.3%) unplanned readmission within 30 days. In 392 hospitals with at least 25 HF hospitalisations, the median RSMR was 10.7% (range 6.1-17.3%) with 59 hospitals significantly different from the national average. Similarly, in 391 hospitals with at least 25 HF hospitalisations, the median RSRR was 22.3% (range 17.7-27.1%) with 24 hospitals significantly different from the average. From 2010-15, the adjusted 30-day mortality [odds ratio (OR) 0.991/month, 95% confidence interval (CI) 0.990-0.992, P< 0.01] and unplanned readmission (OR 0.998/month, 95% CI 0.998-0.999, P< 0.01) rates declined. Within 30 days of a HF hospitalisation, one in 10 patients died and almost a quarter of those surviving experienced an unplanned readmission. The risk of these outcomes varied widely among hospitals suggesting disparities in HF care quality. Nevertheless, a substantial decline in 30-day mortality and a modest decline in readmissions occurred over the study period.

Impact of an extended audit on identifying heart failure patients in general practice: baseline results of the OSCAR-HF pilot study.

AimsIdentifying heart failure (HF) patients in general practice is challenging, and little is known about the current quality of care. We implemented an extended audit from the electronic health records (EHRs) of general practitioners (GPs) to identify HF patients and investigate patient characteristics and quality of care.Methods and resultsThis study describes the baseline results of the OSCAR‐HF pilot study in eight general practices (51 GPs) in Flanders, Belgium. This prospective trial ran for 6 months. Interventions included an extended audit, an N‐terminal pro‐B‐type natriuretic peptide point‐of‐care test, and assistance of a specialist HF nurse. The extended audit searched on risk factors for HF, HF symptoms, signs, and medication in the GPs' EHR to generate a list of possible HF patients. GPs determined which patients had HF. Those HF patients constituted the OSCAR‐HF study population. Each patient file was manually revised to extract biomarker measurements, echocardiography data, and quality indicators. An independent panel of experts assessed the validity of GPs' HF diagnoses. Feedback about the validity of the HF diagnosis was given to the GP. Out of 18 011 patients ≥ 40 years, we identified 310 patients with a registered HF diagnosis before the study start (HF prevalence: 1.7%). The extended audit led to a 74% increase in identified HF patients (n = 538, HF prevalence: 3.0%) with a mean age of 79 ± 11 years. The prevalence of HF with reduced ejection fraction (HFrEF) was 20% (n = 110). A high proportion of patients underwent echocardiography in the past 5 years (86%, n = 462). Natriuretic peptides were rarely available in patients' files (19%, n = 100). Medical specialists should improve communication about the HF diagnosis because a specialist diagnosis was present in only 225 patients (42%) while 67% (n = 359) of the HF diagnoses were judged objectified by a panel of experts. Assigning a diagnosis of HF was particularly difficult in HF patients with preserved EF (HFpEF). HFrEF treatment rates with renin–angiotensin–aldosterone system blockers (84%, n = 92) and beta‐blockers (86%, n = 94) were very good; however, target doses were hardly reached (34% and 14%, respectively).ConclusionsThis study highlighted the need to improve case finding for HF in general practice and showed that an extended audit in the GPs' EHR was a successful strategy to do so. To improve the quality of HF care in general practice, specific strategies are needed to diagnose HFpEF and to reach target doses of disease‐modifying drugs in HFrEF patients.

Inequalities in heart failure care in a tax-financed universal healthcare system: a nationwide population-based cohort study.

AimsData on socioeconomic‐related differences in heart failure (HF) care are sparse. Inequality in care may potentially contribute to a poor clinical outcome. We examined socioeconomic‐related differences in quality of HF care among patients with incident HF with reduced ejection fraction (EF) (HFrEF).Methods and resultsWe conducted a nationwide population‐based cohort study among patients with HFrEF (EF ≤40%) registered from January 2008 to October 2015 in the Danish Heart Failure Registry, a nationwide registry of patients with a first‐time primary HF diagnosis. Associations between individual‐level socioeconomic factors (cohabitation status, education, and family income) and the quality of HF care defined by six guideline‐recommended process performance measures [New York Heart Association (NYHA) classification, treatment with angiotensin‐converting‐enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB), beta‐blockers and mineralocorticoid receptor antagonists, exercise training, and patient education] were assessed using multiple imputation and multivariable logistic regression controlling for potential confounders. Among 17 122 HFrEF patients included, 15 290 patients had data on all six process performance measures. Living alone was associated with lower odds of NYHA classification [adjusted OR (aOR) 0.81; 95% confidence interval (CI): 0.72–0.90], prescription of ACEI/ARB (aOR 0.76; 95% CI: 0.68–0.88) and beta‐blockers (aOR 0.84; 95% CI: 0.76–0.93), referral to exercise training (aOR 0.75; 95% CI: 0.69–0.81), and patient education (aOR 0.73; 95% CI: 0.67–0.80). Compared with high‐level education, low‐level education was associated with lower odds of NYHA classification (aOR 0.93; 95% CI: 0.79–1.11), treatment with ACEI/ARB (aOR 0.99; 95% CI: 0.81–1.20) and beta‐blockers (aOR 0.93; 95% CI: 0.79–1.09), referral to exercise training (aOR 0.73; 95% CI: 0.65–0.82), and patient education (aOR 0.86, 95% CI: 0.75–0.98). An income in the lowest tertile was associated with lower odds of NYHA classification (aOR 0.67; 95% CI: 0.58–0.79), prescription of ACEI/ARB (aOR 0.80, 95% CI: 0.67–0.95) and beta‐blockers (aOR 0.88, 95% CI: 0.86–1.01), referral to exercise training (aOR 0.59, 95% CI: 0.53–0.64), and patient education (aOR 0.66; 95% CI: 0.59–0.74) compared with an income in the highest tertile. Overall, no systematic differences were seen when the analyses were stratified by sex and age groups.ConclusionsLiving alone, low‐level education, and income in the lowest tertile were associated with reduced use of recommended processes of HF care among Danish HFrEF patients with a first‐time primary HF diagnosis. Efforts are warranted to ensure guideline‐recommended HF care to all HFrEF patients, irrespective of socioeconomic background.

Advancing Value-Based Models for Heart Failure: A Call to Action From the Value in Healthcare Initiative's Value-Based Models Learning Collaborative.

Heart failure (HF) is a leading cause of hospitalizations and readmissions in the United States. Particularly among the elderly, its prevalence and costs continue to rise, making it a significant population health issue. Despite tremendous progress in improving HF care and examples of innovation in care redesign, the quality of HF care varies greatly across the country. One major challenge underpinning these issues is the current payment system, which is largely based on fee-for-service reimbursement, leads to uncoordinated, fragmented, and low-quality HF care. While the payment landscape is changing, with an increasing proportion of all healthcare dollars flowing through value-based payment models, no longitudinal models currently focus on chronic HF care. Episode-based payment models for HF hospitalization have yielded limited success and have little ability to prevent early chronic disease from progressing to later stages. The available literature suggests that primary care-based longitudinal payment models have indirectly improved HF care quality and cardiovascular care costs, but these models are not focused on addressing patients' longitudinal chronic disease needs. This article describes the efforts and vision of the multi-stakeholder Value-Based Models Learning Collaborative of The Value in Healthcare Initiative, a collaboration of the American Heart Association and the Robert J. Margolis, MD, Center for Health Policy at Duke University. The Learning Collaborative developed a framework for a HF value-based payment model with a longitudinal focus on disease management (to reduce adverse clinical outcomes and disease progression among patients with stage C HF) and prevention (an optional track to prevent high-risk stage B pre-HF from progressing to stage C). The model is designed to be compatible with prevalent payment models and reforms being implemented today. Barriers to success and strategies for implementation to aid payers, regulators, clinicians, and others in developing a pilot are discussed.

Heart Failure Association of the European Society of Cardiology Quality of Care Centres Programme: design and accreditation document.

Heart failure (HF) is the major contributor to cardiovascular morbidity and mortality. Given its rising prevalence, the costs of HF care can be expected to increase. Multidisciplinary management of HF can improve quality of care and survival. However, specialized HF programmes are not widely available in most European countries. These circumstances underlie the suggestion of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) for the development of quality of care centres (QCCs). These are defined as health care institutions that provide multidisciplinary HF management at all levels of care (primary, secondary and tertiary), are accredited by the HFA/ESC and are implemented into existing health care systems. Their major goals are to unify and improve the quality of HF care, and to promote collaboration in education and research activities. Three types of QCC are suggested: community QCCs (primary care facilities able to provide non-invasive assessment and optimal therapy); specialized QCCs (district hospitals with intensive care units, able to provide cardiac catheterization and device implantation services), and advanced QCCs (national reference centres able to deliver advanced and innovative HF care and research). QCC accreditation will require compliance with general and specific HFA/ESC accreditation standards. General requirements include confirmation of the centre's existence, commitment to QCC implementation, and collaboration with other QCCs. Specific requirements include validation of the centre's level of care, service portfolio, facilities and equipment, management, human resources, process measures, quality indicators and outcome measures. Audit and recertification at 4-6-year intervals are also required. The implementation of QCCs will evolve gradually, following a pilot phase in selected countries. The present document summarizes the definition, major goals, development, classification and crucial aspects of the accreditation process of the HFA/ESC QCC Programme.

Quality of Care for Patients Hospitalized for Heart Failure in China

Given the emerging heart failure (HF) epidemic in China, monitoring and improving the quality of care for heart failure is a top priority. To assess the quality of HF care provided to inpatients by examining the adherence to quality measures for HF care at the hospital level and to identify factors associated with the quality of care. In this multicenter, hospital-based, retrospective cross-sectional study in China, medical records of patients hospitalized for HF from January 1, 2015, to December 31, 2015, were analyzed from January 1, 2018, to May 20, 2019. In the first stage, simple random sampling stratified by economic-geographical regions in China was used to generate a list of participating hospitals. In the second stage, 15 538 hospitalizations from the 189 selected hospitals were systematically sampled, and 10 004 HF hospitalizations were included in the final sample. Adherence to the following 4 core performance measures at the hospital level: (1) left ventricular ejection fraction assessment during hospitalization; (2) evidence-based β-blocker (bisoprolol, carvedilol, or metoprolol succinate) for eligible patients at discharge; (3) angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for eligible patients at discharge; and (4) scheduled follow-up appointment at discharge. At the hospital level, a composite performance score (ranging from 0-1) was also calculated by averaging these measures. In total, 10 004 hospital admissions for HF at 189 hospitals were included in this study. The median (interquartile range [IQR]) patient age at admission was 73 (65-80) years, and 5117 (51.1%) of the patients were men. Among all hospitals, the median rate of adherence to measure 1 was 66.7% (IQR, 45.5%-80.7%; range, 0%-100%). The rate for adherence to measure 2 was 14.8% (IQR, 0%-37.5%; range, 0%-81.8%), and the rate for measure 3 was 57.1% (IQR, 36.4%-75.0%; range, 0%-100%). For measure 4, the median rate of adherence was 11.5% (IQR, 3.3%-32.8%; range, 0%-96.7%). The median (IQR) composite performance score across all hospitals was 40.0% (26.9%-51.9%), with a range from 2.2% to 85.4%. The median odds ratios of adherence were 2.2 (95% CI, 2.0-2.4) for measure 1, 2.1 (95% CI, 1.8-2.4) for measure 2, 2.4 (95% CI, 2.0-2.9 for measure 3, and 4.8 (95% CI, 3.9-5.8) for measure 4 among hospitals. The findings of this study suggest that quality of care for patients with HF in China may be substandard, and there is wide heterogeneity in the quality of care for HF among hospitals. The findings also suggest the need for a national strategy to improve and standardize the quality of HF care in China.

Measuring and Improving the Quality of Heart Failure Care Globally

Measuring and Improving the Quality of Heart Failure Care Globally

Rationale, methodology, and design of Indian College of Cardiology National Heart Failure Registry

Aims: Heart Failure (HF) is a growing epidemic globally and a challenging situation particularly for a country like India. There is paucity of data in the Indian context and the Indian College of Cardiology National Heart Failure Registry (ICCNHFR) would be the first of its kind in understanding the aetiology, demographics and treatment pattern in the country. The rationale and design of the study is described. Methods and Results: This is a prospective observational registry study of Acute Decompensated Heart Failure (ADHF) across various hospitals in India. This would include data of consecutive adult patients admitted with acute heart failure in the hospitals. This study is from Sep 2019 to Sep 2021 and is expected to enroll about 10000 patients. The primary data would be to analyse the demographics, aetiology, comorbid conditions, inhospital mortality, 30 day and one year mortality and rehospitalisation. The secondary aim would be understand the diagnostic patterns and therapeutic options offered for these patients.Conclusion: The present registry is designed to analyse the national data on ADHF. This would identify gaps in HF care and therapy. This would help in improving quality of heart failure care in the country and better resource utilization. This will help in the reduction of mortality and morbidity rate related to HF

Reducing Structural Inequities in Heart Failure Management: An Approach to Improve the Quality of Heart Failure Care on the General Medicine Service: Longitudinal Equity Action Plan (LEAP)

Reducing Structural Inequities in Heart Failure Management: An Approach to Improve the Quality of Heart Failure Care on the General Medicine Service: Longitudinal Equity Action Plan (LEAP)

The China Patient-centred Evaluative Assessment of Cardiac Events (PEACE) prospective heart failure study design

IntroductionChina faces the prospect of a large growth in the prevalence of heart failure (HF). However, there is limited knowledge about outcomes in patients after HF hospitalisations, including patient-reported outcomes...

Essential Elements of Early Post Discharge Care of Patients with Heart Failure.

Heart failure is associated with an enormous burden on both patients and health care systems in the USA. Several national policy initiatives have focused on improving the quality of heart failure care, including reducing readmissions following hospitalization, which are common, costly, and, at least in part, preventable. The transition from inpatient to ambulatory care setting and the immediate post-hospitalization period present an opportunity to further optimize guideline concordant medical therapy, identify reversible issues related to worsening heart failure, and evaluate prognosis. It can also provide opportunities for medication reconciliation and optimization, consideration of device-based therapies, appropriate management of comorbidities, identification of individual barriers to care, and a discussion of goals of care based on prognosis. Recent studies suggest that attention to detail regarding patient comorbidities, barriers to care, optimization of both diuretic and neurohormonal therapies, and assessment of prognosis improve patient outcomes. Despite the fact that the transition period appears to be an optimal time to address these issues in a comprehensive manner, most patients are not referred to programs specializing in this approach post hospital discharge. The objective of this review is to provide an outline for early post discharge care that allows clinicians and other health care providers to care for these heart failure patients in a manner that is both firmly rooted in the guidelines and patient-centered. Data regarding which intervention is most likely to confer benefit to which subset of patients with this disease is lacking and warrants further study.

Abstract 251: Gender Equity in Rates of Guideline-Directed Medical Therapy Prescription at Discharge for Hospitalized Heart Failure Patients

Background: Heart failure (HF) is an increasingly prevalent condition with significant morbidity and mortality. Guideline-directed medical therapy (GDMT) reduces morbidity and mortality in heart failure with reduced ejection fraction, but continues to be under-prescribed. There is a paucity of data on the impact of patient gender on the quality of HF care, although it has previously been shown that women with other cardiovascular conditions, such as coronary artery disease, receive less intensive treatment. We sought to determine whether there is a difference in rates of prescription of GDMT for patients hospitalized with heart failure by gender with the hypothesis that rates of GDMT prescription in women would be lower than that in men. Methods: Over a six month study window, we identified 246 patients discharged from an urban academic medical center with a primary discharge diagnosis of systolic heart failure. Systematic chart review was performed to identify whether patients were discharged with the following medications: angiotensin converting enzyme inhibitor (ACE-I), angiotensin receptor blocker (ARB), beta blocker (BB), mineralocorticoid receptor antagonist (MRA), hydralazine and a nitrate, and neprilysin inhibitor/ARB. Statistical analysis was performed to evaluate for an association between rates of GDMT prescription and gender. Regression analysis was then performed to adjust for age, weight, serum potassium, and 1/(discharge creatinine). Results: At the time of discharge, there was no statistically significant difference in the rate of GDMT prescription for females compared to males in either the unadjusted or adjusted models. ACE-I or ARB prescription rates were 59% in females and 50% in males (p=0.11); BB prescription rates were 89% in females and 84% in males (p=0.27); MRA prescription rates were 43% in females and 52% in males (p=0.19). Prescription rates of combination therapy of ACE-I or ARB with BB and MRA were 30% in females and 31% in males (p=0.78). There was a significant difference in 30 day all-cause unadjusted readmission rates in females (22%) compared to males (37%) (p&lt;0.05). Conclusions: In this sample of hospitalized heart failure patients, no difference was found in rates of GDMT prescription for women as compared to men. Readmission rates were significantly higher for men than women, consistent with national data. Further investigation will determine the extent to which equity in prescription rates translates into improved outcomes for women hospitalized with heart failure.

Quality of Care and Outcomes of Heart Failure Among Patients With Schizophrenia in Denmark

Research on the association between schizophrenia and the quality of care and clinical outcomes of heart failure (HF) remains sparse. This nationwide study compared the quality of care and clinical outcomes of HF among Danish patients with and without schizophrenia. In a population-based cohort study, we identified 36,718 patients with incident HF with hospital contacts, including 108 with schizophrenia, using Danish registries between 2004 and 2013. High quality of HF care was defined as receiving ≥ 80% guideline-recommended process-performance measures of care. Potential predictors of HF care among patients with schizophrenia included patient-specific factors (age, gender, Global Assessment of Functioning [GAF] score, alcohol or drug abuse, duration of schizophrenia); provider-specific factors (quality of schizophrenia care); and system-specific factors (patient-volume defined as hospital departments and clinics yearly average patient-volume of patients with incident HF). Clinical outcomes included 4-week all-cause readmission and 1-year all-cause mortality after a first-time hospital contact with incident HF. Results showed that compared with patients with incident HF who have no schizophrenia, patients with incident HF who have schizophrenia had a lower chance of receiving high-quality HF care (relative risk 0.66, 95% confidence interval 0.48 to 0.91). A high GAF score was associated with a higher chance of receiving high-quality HF care among patients with incident HF who have schizophrenia. Patients with incident HF who have schizophrenia had a higher risk of 1-year mortality (adjusted hazard ratio 2.83, 95% confidence interval 1.59 to 5.04), but not a higher risk of readmission than patients with incident HF who have no schizophrenia. In conclusion, efforts are warranted to reduce the high mortality among patients with incident HF who have schizophrenia.

Areas for quality improvements in heart failure care: quality of care from the family members' perspective.

The complex needs of people with chronic heart failure (HF) place great demands on their family members, and it is important to ask family members about their perspectives on the quality of HF care. To describe family members' perceptions of quality of HF care in an outpatient setting. A cross-sectional study using a short form of the Quality from Patients' Perspective (QPP) questionnaire for data collection. The items in the questionnaire measure four dimensions of quality, and each item consists of both the perceived reality of the care and its subjective importance. The study included 57 family members of patients with severe HF in NYHA class III-IV. Family members reported areas for quality improvements in three out of four dimensions and in dimensionless items. The lowest level of perceived reality was reported for treatment for confusion and loss of appetite. Treatment for shortness of breath, access to the apparatus and access to equipment necessary for medical care were the items with the highest subjective importance for the family members. Family members identified important areas for quality improvement in the care for patients with HF in an outpatient setting. In particular, symptom alleviation, information to patients, patient participation and access to care were identified as areas for improvements. Thus, measuring quality from the family members' perspective with the QPP might be a useful additional perspective when it comes to the planning and implementation of changes in the organisation of HF care.