| Improving evidence-based care for heart failure in outpatient cardiology practices: primary results of the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF). | |
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MedLine Citation:
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PMID: 20660805 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: A treatment gap exists between heart failure (HF) guidelines and the clinical care of patients. The Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) prospectively tested a multidimensional practice-specific performance improvement intervention on the use of guideline-recommended therapies for HF in outpatient cardiology practices. METHODS AND RESULTS: Performance data were collected in a random sample of HF patients from 167 US outpatient cardiology practices at baseline, longitudinally after intervention at 12 and 24 months, and in single-point-in-time patient cohorts at 6 and 18 months. Participants included 34 810 patients with reduced left ventricular ejection fraction (< or =35%) and chronic HF or previous myocardial infarction. To quantify guideline adherence, 7 quality measures were assessed. Interventions included clinical decision support tools, structured improvement strategies, and chart audits with feedback. The performance improvement intervention resulted in significant improvements in 5 of 7 quality measures at the 24-month assessment compared with baseline: beta-blocker (92.2% versus 86.0%, +6.2%), aldosterone antagonist (60.3% versus 34.5%, +25.1%), cardiac resynchronization therapy (66.3% versus 37.2%, +29.9%), implantable cardioverter-defibrillator (77.5% versus 50.1%, +27.4%), and HF education (72.1% versus 59.5%, +12.6%) (each P<0.001). There were no statistically significant improvements in angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use or anticoagulation for atrial fibrillation. Sensitivity analyses at the patient level and limited to patients with both baseline and 24-month quality measure data yielded similar results. Improvements in the single-point-in-time cohorts were smaller, and there were no concurrent control practices. CONCLUSIONS: The Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting, a defined and scalable practice-specific performance improvement intervention, was associated with substantial improvements in the use of guideline-recommended therapies in eligible patients with HF in outpatient cardiology practices. CLINICAL TRIAL REGISTRATION:URL: http://www.clinicaltrials.gov. Unique identifier: NCT00303979. |
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Authors:
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Gregg C Fonarow; Nancy M Albert; Anne B Curtis; Wendy Gattis Stough; Mihai Gheorghiade; J Thomas Heywood; Mark L McBride; Patches Johnson Inge; Mandeep R Mehra; Christopher M O'Connor; Dwight Reynolds; Mary Norine Walsh; Clyde W Yancy |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2010-07-26 |
Journal Detail:
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Title: Circulation Volume: 122 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-08-10 Completed Date: 2010-08-31 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 585-96 Citation Subset: AIM; IM |
Affiliation:
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Department of Medicine, Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA 90095-1679, USA. gfonarow@mednet.ucla.edu |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00303979 |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Ambulatory Care / standards*, trends Ambulatory Care Facilities / standards*, trends Cardiology / standards*, trends Cohort Studies Evidence-Based Medicine / standards*, trends Female Heart Failure / diagnosis, therapy* Humans Longitudinal Studies Male Middle Aged Practice Guidelines as Topic / standards Prospective Studies Registries / standards* |
| Comments/Corrections | |
Comment In:
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Circulation. 2010 Aug 10;122(6):561-6
[PMID:
20660800
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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