third of heart failure patients left hospitals without
some of the tried-and-true therapies that could add years to
their lives, according to one of the largest studies of its
kind, reported at the American Heart Association’s Scientific
“There is marked
variation and a lack of structure in cardiovascular care in the
nation’s hospitals,” said lead investigator Gregg C. Fonarow,
M.D., the Eliot Corday Chair in Cardiovascular Medicine and
Science at the University of California at Los Angeles.
“There is a lot
more that can be done before heart failure patients leave the
hospital to improve the quality of patients’ lives and make sure
they continue to do well.”
data on the first 33,046 patients enrolled in ADHERE, covering
the period from its launch in September 2001 through January
Decompensated Heart failurE national REgistry) is an ongoing
observational registry of patients hospitalized with a primary
diagnosis of acute heart failure. The registry includes 250
hospitals across the United States. About 100,000 patients from
community, tertiary and academic institutions are enrolled.
assessed four quality of care indicators: 1) patients received a
complete set of discharge instructions; 2) left ventricular
function was measured (to determine the heart’s pumping
ability); 3) ACE-inhibitors were prescribed at discharge (unless
the patient had a medical reason for not taking the drug); and
4) current smokers received smoking cessation counseling.
age 72 on average, 52 percent were female, and 59 percent had
coronary artery disease. Their average hospital stay was 4.5
days, and 4.2 percent of the participants died in the hospital.
percent of ideal candidates for ACE-inhibitors were discharged
without receiving this life-prolonging therapy; 72 percent were
discharged without receiving a complete set of discharge
instructions. This includes information about their
medications, a follow-up appointment, signs to look for and what
actions to take if they have problems, and information on a low
sodium diet and physical activity.
They also found
that 69 percent of current or recent smokers were not counseled
on smoking cessation. Left ventricular function was not
assessed in 18 percent of patients. “While some hospitals
provide a high quality of care according to these performance
measures, others are clearly lagging,” Fonarow said.
exist because they have been proven to benefit patients by
increasing survival and reducing the risk of
re-hospitalization. If hospitals improved their adherence to
the guidelines, it would have a huge impact on the lives of
heart failure patients,” he added.
Clyde W. Yancy,
M.D., associate professor of internal medicine in the division
of cardiology at the University of Texas Southwestern Medical
Center in Dallas and a co-author of the study, said, “The
American Heart Association’s Get With The Guidelines program
emphasizes standard of care practices for coronary artery
disease patients. The same kind of model would help hospitals
provide more uniform care for heart failure patients.”
is Stephen F. Chang of the Department of Biostatistics at Scios,
Inc., of Fremont, Calif. and the ADHERE Scientific Advisory
Board and Investigators. The ADHERE registry is sponsored by