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

Guideline-directed medical therapy (GDMT) optimization and effective de-congestion are known to improve outcomes in admitted heart failure (HF) patients, yet their implementation is suboptimal. Using an HF decision aid and point-of-care ultrasound (POCUS) at admission, this resident-led quality improvement (QI) initiative aimed to improve GDMT use and reduce HF readmissions.

This prospective, single-center QI initiative compared resident-performed POCUS and HF decision-aid use (the QI arm) with routine hospital care in admitted HF patients. Assignment to the QI arm was based on the availability of residents trained to perform POCUS on admission.

30-day hospital readmission; secondary outcomes: GDMT utilization using a standard score, adverse outcome occurrence, and 30-day mortality.

The study was terminated early due to funding constraints. We enrolled 103 (42 in the QI arm) out of the planned 254 patients. At discharge, the QI arm had a trend towards improvement in GDMT scores (+21 ± 23% vs. +12 ± 24% in controls, p = 0.106). In particular, a numerically higher proportion of patients in the QI arm were discharged on renin-angiotensin-aldosterone blockers (70.4% vs. 51.4% of controls, p = 0.126). Adverse effect occurrence and 30-day outcomes (readmissions and mortality) were not significantly different between groups. Significantly more people in the QI arm had a transthoracic echocardiogram in the hospital (26 [65.0%] vs. control: 21 [38.9%], p = 0.012).

This study showed that a resident-led QI initiative was feasible and resulted in modest improvement in GDMT use and echocardiography utilization, but without effectively altering 30-day outcomes.