Treatment quality for heart failure should be measured on guideline adherence, not patient volume

By Dr. Ananya Mandal, MDJan 30 2018

A new study has found that adherence to treatment guidelines, not patient volume, is a better method of predicting treatment outcomes for patients with heart failure. The study was recently published in the journal Circulation.

Credit: Dmitry Kalinovsky/Shutterstock.com

Heart failure is a condition that causes a reduction in the heart's ability to pump blood. Normally, the heart pumps blood to supply vital nutrients and oxygen to all parts of the body.

In heart failure, the heart has difficulty pumping adequately and starts to function in an abnormal manner to compensate. This is a chronic condition that needs to be managed with medications.

The American Heart Association's 2017 Heart Disease and Stroke Statistical Update reported that 6.5 million Americans suffer from heart failure, and numbers look only set to rise.

The current study was led by Dr Dharam Kumbhani, M.D. S.M, assistant professor of medicine and a cardiologist at UT Southwestern Medical Center in Dallas.

There is a feeling that hospitals that perform more procedures or treat more patients for a certain condition are likely to have better outcomes. But what we have found in this study, and others we have conducted, is that patients at hospitals with established processes of care fare better.”

Dr Dharam Kumbhani, M.D. S.M, Lead Author and Assistant Professor of Medicine at UT Southwestern Medical Center, Dallas.

The team looked at the medical records of 125,595 patients who were over the age of 65. All patients had developed heart failure and subsequently underwent treatment at 342 hospitals.

These hospitals were all a part of the “Get With The Guidelines” initiative by the American Heart Association, which took place between 2005 to 2014. The number of patients admitted with heart failure each year ranged between 5 and 147 in each of the hospitals.

The results showed that the hospitals who admitted more patients also adhered to the process measures for heart failure as prescribed by the AHA. This included testing, administering appropriate drugs and counseling for smoking cessation.

These hospitals also prescribed more number of cardiac resynchronization therapy devices and implantable cardioverter defibrillators upon discharge.

In hospitals that adhered to the guidelines, there was no difference in readmissions or death rates both during the patients’ stay in hospital and within 30 days of discharge.

Compared to hospitals that did not adhere to the guidelines, deaths and readmissions within 6 months of discharge were lower.

Going to a high-volume medical center for heart failure doesn't guarantee that you'll have the best outcomes. Identifying the hospitals that provide the best care is more complicated than that, and patients and health policy makers should recognize that smaller-volume hospitals can deliver outstanding care."

Dr Dharam Kumbhani, M.D. S.M, Lead Author and Assistant Professor of Medicine at UT Southwestern Medical Center, Dallas.