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Quality of congestive heart failure treatment at a Canadian teaching hospital
Insights
Physicians at a Canadian hospital largely followed congestive heart failure (CHF) guidelines for testing and angiotensin-converting enzyme (ACE) inhibitor prescriptions. However, optimal dosing of ACE inhibitors requires further attention and education.
Area of Science:
- Cardiology
- Internal Medicine
- Health Services Research
Background:
- Practice guidelines recommend left ventricular function assessment and angiotensin-converting enzyme (ACE) inhibitor use for congestive heart failure (CHF).
- Previous studies indicate suboptimal adherence to these CHF management guidelines.
- Physician compliance with established CHF protocols needs evaluation.
Purpose of the Study:
- To assess physician adherence to published congestive heart failure (CHF) management guidelines.
- To evaluate the utilization of left ventricular function testing and ACE inhibitor therapy in CHF patients.
- To identify areas for improvement in CHF care at a Canadian teaching hospital.
Main Methods:
- Retrospective chart review of 200 patients admitted with congestive heart failure (CHF).
- Quality of care assessed by left ventricular function testing, ACE inhibitor prescription rates, and target dose achievement.
- Analysis of patient data from Sunnybrook & Women's College Health Sciences Centre, Toronto.
Main Results:
- Left ventricular function testing was administered to 88.5% of CHF patients.
- Of those with systolic dysfunction, 89% received ACE inhibitors.
- Only 23% of eligible patients were prescribed target doses of ACE inhibitors.
Conclusions:
- Most congestive heart failure (CHF) patients at this institution received recommended testing and ACE inhibitor therapy.
- Adherence to ACE inhibitor therapy initiation is high.
- Focusing on adequate ACE inhibitor dosing is crucial for future educational interventions in CHF management.
Background:
Practice guidelines for the management of congestive heart failure (CHF) emphasize the need for assessment of left ventricular function and treatment with angiotensin-converting enzyme (ACE) inhibitors. However, previous studies have shown that many patients do not receive these tests or medications. The objective of this study was to evaluate the compliance of physicians at a large Canadian teaching hospital with published CHF management guidelines.
Methods:
We conducted a retrospective review of the charts of 200 patients admitted to Sunnybrook & Women's College Health Sciences Centre, Toronto, in 1997 for whom CHF was the diagnosis most responsible for the hospital admission. Quality of care was measured with 3 indicators: the use of left ventricular function testing to determine systolic versus diastolic dysfunction; the prescription of ACE inhibitors to appropriate patients (those with systolic dysfunction, no contraindications to ACE inhibitor therapy and no angiotensin II receptor blocker use); and the prescription of target doses of ACE inhibitors.
Results:
Of the 200 patients 177 (88.5%) received left ventricular function testing before or during their hospital stay; of the 177, 117 (66.1%) had systolic dysfunction. A total of 100 patients were considered to be ideal candidates for ACE inhibitor treatment. Of the 100, 89 (89.0%) received ACE inhibitors; however, only 23 (23.0%) were prescribed target doses.
Interpretation:
Most patients who had CHF at this Canadian hospital received left ventricular function testing and ACE inhibitor therapy. Future educational efforts should focus on the importance of adequate dosing of ACE inhibitors.
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