A Resident-Led Quality Improvement Initiative to Accelerate Medical Therapy Implementation in Acute Heart Failure:...

Area of Science:

• Cardiology
• Quality Improvement Science
• Medical Education

Background:

• Guideline-directed medical therapy (GDMT) optimization and decongestion are crucial for hospitalized heart failure (HF) patients but are often underutilized.
• A quality improvement (QI) initiative was designed to enhance GDMT and reduce readmissions using an HF decision aid and point-of-care ultrasound (POCUS).

Purpose of the Study:

• To assess the impact of a resident-led QI initiative on GDMT utilization and 30-day outcomes in hospitalized HF patients.
• To evaluate the feasibility of integrating POCUS and decision aids into routine HF care.

Main Methods:

• A prospective, single-center QI initiative compared POCUS and decision aid use (QI arm) against standard care for admitted HF patients.
• Assignment to the QI arm depended on resident availability and training in POCUS.
• Primary outcome was 30-day hospital readmission, with secondary outcomes including GDMT utilization, adverse events, and mortality.

Main Results:

• The study enrolled 103 patients and was terminated early due to funding.
• The QI arm showed a trend toward improved GDMT scores and higher use of renin-angiotensin-aldosterone blockers at discharge.
• Significantly more patients in the QI arm received a transthoracic echocardiogram, but 30-day readmissions and mortality were not significantly different.

Conclusions:

• A resident-led QI initiative using POCUS and decision aids is feasible for improving GDMT and echocardiography use in HF patients.
• Despite modest improvements in care metrics, this initiative did not significantly impact 30-day readmission or mortality rates.
• Further research is needed to optimize QI strategies for better clinical outcomes in HF.