Heart Failure Updates from GWTG - Winter 2011-2012

Updated:Mar 2,2012

Association of Race/Ethnicity with Clinical Risk Factors, Quality of Care, and Acute Outcomes in Patients Hospitalized with Heart Failure
Thomas KL, Hernandez AF, Dai D, Heidenreich P, Fonarow GC, Peterson ED, Yancy CW. Am Heart J 2011;161(4):746-54.
  • In this very large, diverse racial/ethnic cohort of patients hospitalized with heart failure at institutions from all regions of the country over a 3-year period, the investigators found substantial differences in baseline characteristics among black, Hispanic, and white patients, particularly in age of presentation.
  • The strikingly younger age and higher prevalence of obesity, hypertension, and diabetes mellitus among Hispanic and black patients indicate that health improvement efforts should focus on early prevention of these risk factors in an attempt to reduce the incidence of HF and its long-term morbidity and mortality in these populations.
  • Despite having more cardiovascular disease risk factors and some indicators of more advanced HF, black and Hispanic patients with HF had lower rates of in-hospital mortality than white patients. 
Payment Source, Quality of Care, and Outcomes in Patients Hospitalized with Heart Failure
Kapoor JR, Kapoor R, Hellkamp AS, Hernandez AF, Heidenreich PA, Fonarow GC. J Am Coll Cardiol 2011;58:1465-71.
 For patients hospitalized with HF, there was an observed decrease in quality of care and outcomes in the following groups when compared to private groups:
  • No insurance
  • Medicaid
  • Medicare
The Importance of Consistent, High-Quality, Acute Myocardial Infarction and Heart Failure Care: Results from AHA GWTG Program
Wang TY, Dai D, Hernandez AF, Bhatt DL, Heidenreich PA, Fonarow GC, Peterson ED. J Am Coll Cardiol 2011;58:637-44.
  • Significantly lower risk-adjusted mortality was reported at participating hospitals that had better performance for both HF and acute myocardial infarction care as opposed to either alone or neither.
  • This suggests further consideration of whether a single scoring system would facilitate more consistent quality improvement and improved outcomes.
Predictors of Hospital Length of Stay in Heart Failure
Whellan DJ, Zhao X, Hernandez AF, Liang L, Peterson ED, Bhatt DL, Heidenreich PA, Schwamm LH, Fonarow GC. J Card Fail 2011;17(8):649-56.
  • Patients with longer lengths of stay have higher comorbidities and greater disease severity–based vitals at admission and BNP levels.
  • There are limited opportunities to risk stratify for length of stay based on hospital characteristics and patient admission.
GWTG Program Participation, Process of Care and Outcome for Patients Hospitalized with HF
Heidenreich PA, Hernandez AF, Yancy CW, Liang L, Peterson ED, Fonarow GC. Circulation: Cardiovascular Quality and Outcomes 2012;5:37-43.
  • There is evidence that the GWTG-HF program demonstrates better processes of care than other hospitals, but there are few clinical differences in patient outcomes.
  • This paper suggests identifying new opportunities to incorporate outcomes-related metrics in the GWTG.

Patient and Hospital Characteristics Associated with Traditional Measures of Inpatient Quality of Care for Patients with Heart Failure
Heidenreich PA, Zhao X, Hernandez AF, Yancy CW, Fonarow GC. Am Heart J 2012;163:239-245.e3.

  • Guidelines-based recommended HF care is less likely in older patients, patients with abnormal renal function and those treated at smaller hospitals. 
  • This suggests tailoring interventions for smaller hospitals and for older patients with comorbidities.

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