Hospitals improve adherence to heart failure guidelines regardless of teaching status

From 2005 to 2014, hospitals participating in the Get With The Guidelines (GWTG) program improved their adherence to heart failure performance measures, according to a database analysis.

After adjusting for baseline patient and hospital characteristics, teaching and nonteaching hospitals had similar adherence to guidelines for treating heart failure patients with reduced or preserved ejection fraction.

Lead researcher Dhavalkumar B. Patel, MD, MPH, of Virginia Commonwealth University in Richmond, Virginia, and colleagues published their results online Oct. 25 in Circulation: Cardiovascular Quality and Outcomes.

The researchers evaluated data on 197,187 heart failure patients admitted to teaching hospitals and 106,924 heart failure patients admitted to nonteaching hospitals between 2005 and 2014. All of the hospitals participated in the GWTG program and submitted clinical information for each patient using an internet-based patient management tool.

Patients treated at teaching hospitals were younger and more likely to be black and uninsured and have a previous history of heart failure.

Amgen Cardiovascular sponsors the GWTG-heart failure program. Medtronic, GlaxoSmithKline, Ortho-McNeil and the American Heart Association Pharmaceutical Roundtable have funded the program in the past.

The researchers found that defect-free care occurred in 88.2 percent of patients at teaching hospitals and 85.8 percent of patients at nonteaching hospitals. After adjusting for patient and hospital characteristics, there was no significant difference in defect-free care between the groups. The researchers defined defect-free care as 100 percent compliance with all required performance measures.

During the study, there was increased adherence for several performance measures, including defect-free care, discharge instructions, documentation of left ventricular ejection fraction, beta-blockers and ACE inhibitors/ARBs for patients with left ventricular dysfunction and smoking cessation. There was no significant difference in the adherence trends between teaching and nonteaching hospitals.

Hospital stays of four days or longer were similar between the groups, although the odds of mortality were higher at teaching hospitals. In addition, cardiac resynchronization therapy (CRT) defibrillator or CRT pacemaker placement or prescription was only increased at teaching hospitals.

Although the researchers adjusted for the pertinent factors that were collected, they mentioned that there might have been differences between teaching and nonteaching hospitals that they could not adjust for. They also noted that the GWTG program did not have data on postdischarge outcomes. In addition, hospitals volunteer to participate in the program, so the results might not be generalizable to other hospitals. 

“The improvements in care over time may reflect more than GWTG-[heart failure] participation, additional local and national improvement efforts, public reporting of acute [heart failure] measures, or other factors,” the researchers wrote.