“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.”

Fonarow presented data on the first 33,046 patients enrolled in ADHERE, covering the period from its launch in September 2001 through January 2003. 

ADHERE (Acute 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.

The researchers 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.

Participants were 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.

Thirty-one 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.

“These standards 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.”