Quality of care for elderly patients hospitalized with heart failure

There is increasing interest in the development of explicit criteria to evaluate the quality of care for patients with heart failure. However, despite this interest, there is a paucity of information about the care of these patients in actual clinical practice across diverse sites.

We conducted a retrospective medical record review across 9 acute care hospitals in Connecticut. We selected 200 random admissions from each hospital with a principal discharge diagnosis of heart failure in 1994. Hospitals with fewer than 200 cases had 100% of cases selected. Patients with heart failure secondary to severe aortic stenosis, mitral stenosis, or medical illness were excluded. We evaluated the percentage of patients receiving appropriate treatments and interventions as defined by quality-of-care indicators derived from the Agency for Health Care Policy and Research Clinical Practice Guidelines.

Data were abstracted from 1623 hospitalizations and the presence of heart failure was validated by chart review in 1535 (95%). In cohorts of ideal candidates for specific interventions, 832 (75%) of 1110 had a left ventricular ejection fraction documented or measured; 346 (86%) of 401 received angiotensin-converting enzyme inhibitors; 38 (14%) of 271 received target doses of angiotensin-converting enzyme inhibitors; 1359 (97%) of 1400 had counseling about medications documented; 90 (6%) of 1400 had counseling about weight documented; 980 (70%) of 1400 had counseling about diet documented; 856 (61%) of 1400 had counseling about exercise and activity documented; and 14 (11%) of 128 smokers had counseling about cessation documented.

These data demonstrate that the documentation of left ventricular systolic function and counseling for diet, weight, activity, and smoking may provide the best opportunities to improve the hospital care of elderly patients with heart failure. The use of angiotensin-converting enzyme inhibitors in appropriate patients is relatively high, indicating successful translation of trial results into clinical practice at these hospitals.