Patient and Practice Factors Associated With Improvement in Use of Guideline-Recommended Therapies for Outpatients With Heart Failure (from the IMPROVE HF Trial) - 06/08/11
, Nancy M. Albert, PhD, RN b, Anne B. Curtis, MD c, Mihai Gheorghiade, MD d, J. Thomas Heywood, MD e, Mark L. McBride, PhD f, Patches Johnson Inge, PhD f, Mandeep R. Mehra, MD g, Dwight Reynolds, MD h, Mary Norine Walsh, MD i, Clyde W. Yancy, MD j, Gregg C. Fonarow, MD k
Corresponding author: Tel: 919-681-6195; fax: 919-681-7755Résumé |
Diverse factors are associated with variations in evidence-based treatment of outpatients with heart failure (HF). However, patient and practice characteristics associated with improved use of guideline-recommended therapies over time have not been well studied. The Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) is a prospective evaluation of a performance improvement initiative conducted at 167 practices treating outpatients with diagnosed HF or previous myocardial infarction and left ventricular ejection fraction ≤35%. Patient characteristics and care practice data were collected by chart abstraction at baseline and 24 months for 14,236 patients. Seven individual care measures and a composite measure were assessed. Practices were stratified by tertiles of composite measure improvement, and significant, independent patient and practice factors associated with improvement in the composite measure at 24 months were examined. The baseline composite performance measure was 68.4%, which increased to 80.1% at 24 months (+11.6%, p <0.001). The composite measure improvement tertiles were ≤8%, >8% to 15%, and >15%. Multivariate analyses revealed greater improvements associated only with lower practice baseline composite measure rates (p <0.001). Logistic regression showed that 2 additional variables were inversely associated with practices in the highest tertile in composite measure improvement (>15%): southern practice location (p = 0.0239) and edema (p = 0.0047). In conclusion, few patient and practice factors were associated with greater or lesser overall improvements over time in the use of guideline-recommended HF therapies. Other factors may be more important determinates of the magnitude of care improvements over time among cardiology practices participating in a performance improvement initiative.
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| The Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) and this study are sponsored by Medtronic, Minneapolis, Minnesota. Dr. O'Connor has been a consultant for Forest Laboratories New York, New York, Medtronic, Amgen, Thousand Oaks, California, Medpace, Cincinnati, Ohio, Impulse Dynamics, Orangeburg, New York, Actelion, South San Francisco, California, Cytokinetics, South San Francisco, California, Roche, Basel, Switzerland, and Trevena, King of Prussia, Pennsylvania. Dr. Albert has been a consultant for Medtronic. Dr. Curtis has received research grants from Medtronic and St. Jude Medical, St. Paul, Minnesota, and has been on the speaker's bureau for Medtronic, St. Jude Medical, and Sanofi-Aventis, Bridgewater, New Jersey. Dr. Curtis has been a consultant for St. Jude Medical, Medtronic, and Biosense Webster, Diamond Bar, California, and received fellowship support from Medtronic. Dr. Gheorghiade is or has been a consultant for Debiopharm, Lausanne, Switzerland, Errekappa Terapeutici, Milan, Italy, GlaxoSmithKline, Research Triangle Park, North Carolina, Johnson & Johnson, New Brunswick, New Jersey, Protein Design Labs, Incline Village, Nevada, Medtronic, Sanofi-Aventis, Merck, Whitehouse Station, New Jersey, Novartis Pharma AG, Basel, Switzerland, Otsuka Pharmaceuticals, Princeton, New Jersey, Pericor Therapeutics, New York, New York, Sigma Tau, Gaithersburg, Maryland, and Solvay, Abbott Park, Illinois. Dr. Heywood has received research grants from Medtronic and St. Jude Medical and has been on the speaker's bureaus for AstraZeneca, Wilmington, Delaware, GlaxoSmithKline, Guidant, Indianapolis, Indiana, Medtronic, Novartis, East Hanover, New Jersey, Pfizer, New York, New York, and Scios, Mountain View, California. Dr. Heywood has also been a consultant for or on advisory boards for GlaxoSmithKline, Medtronic, and Scios. Dr. Mehra has been a consultant for Medtronic, Orqis, Carlsbad, California, Johnson & Johnson, New Brunswick, New Jersey, Solvay, PeriCor, and St. Jude Medical. Dr. Mehra has received grant and research support from the National Institutes of Health, Bethesda, Maryland, Maryland Industrial Partnerships, College Park, Maryland, and Maryland Tobacco Fund, Baltimore, Maryland. Dr. Reynolds has received research grants from Biotronik, Berlin, Germany, and Medtronic and has been on the speaker's bureaus for Medtronic and Sorin, Minneapolis, Minnesota. He has been a consultant for Medtronic. Dr. Walsh has been a consultant for Boston Scientific, Natick, Massachusetts, Medtronic, United Health Care, Minneapolis, Minnesota, and EMERGE, Denver, Colorado. Dr. Fonarow has received research grants from the National Institutes of Health and has been a consultant for Medtronic, Novartis, and St. Jude Medical. Dr. Fonarow has received honoraria from Medtronic, GlaxoSmithKline, Pfizer, and St. Jude Medical. |
Vol 107 - N° 2
P. 250-258 - janvier 2011 Retour au numéro
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