Influence of dedicated heart failure clinics on delivery of recommended therapies in outpatient cardiology practices: Findings from the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF)

Albert, Nancy M.; Fonarow, Gregg C.; Yancy, Clyde W.; Curtis, Anne B.; Stough, Wendy Gattis; Gheorghiade, Mihai; Heywood, J. Thomas; McBride, Mark; Mehra, Mandeep R.; O'Connor, Christopher M.; Reynolds, Dwight; Walsh, Mary Norine

doi:10.1016/j.ahj.2009.11.022

« Previous Next »American Heart Journal
Volume 159, Issue 2 , Pages 238-244, February 2010

Influence of dedicated heart failure clinics on delivery of recommended therapies in outpatient cardiology practices: Findings from the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF)

Nancy M. Albert, PhD, RN
- Nursing Institute and Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, OH
- Reprint requests: Nancy M. Albert, PhD, RN; 9500 Euclid Avenue, Mailcode J3-4, Cleveland, OH 44195.
Gregg C. Fonarow, MD
- UCLA Medical Center, Los Angeles, CA
Clyde W. Yancy, MD
- Baylor University Medical Center, Dallas, TX
Anne B. Curtis, MD
- University of South Florida College of Medicine, Tampa, FL
Wendy Gattis Stough, PharmD
- Campbell University School of Pharmacy, Research Triangle Park, NC
- Duke University Medical Center, Durham, NC
Mihai Gheorghiade, MD
- Northwestern University, Feinberg School of Medicine, Chicago, IL
J. Thomas Heywood, MD
- Scripps Clinic, La Jolla, CA
Mark McBride, PhD
- Outcome Sciences, Inc, Cambridge, MA
Mandeep R. Mehra, MD
- University of Maryland, Baltimore, MD
Christopher M. O'Connor, MD
- Duke University Medical Center, Durham, NC
Dwight Reynolds, MD
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
Mary Norine Walsh, MD
- The Care Group, LLC, Indianapolis, IN

Received 16 October 2009; accepted 24 November 2009.

Background

National guidelines recommend heart failure (HF) disease management programs to facilitate adherence to evidence-based practices. This study examined the influence of dedicated HF clinics on delivery of guideline-recommended therapies for cardiology practice outpatients with HF and reduced left ventricular ejection fraction.

Methods

IMPROVE HF, a prospective cohort study, enrolled 167 cardiology practices to characterize outpatient management of 15,381 patients with chronic systolic HF. Adherence to guideline-recommended HF therapies was recorded, and the presence of a dedicated HF clinic was assessed by survey. Multivariate models identified contributions to delivery of guideline-recommended HF therapies.

Results

Of practices, 41.3% had a dedicated HF clinic. Practices with a dedicated HF clinic had greater adherence to 3 of 7 guideline-recommended HF therapy measures: angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (P = .02), β-blocker (P = .025), and HF education (P = .009). After adjustment, use of a dedicated HF clinic was associated with greater conformity in 2 of 7 measures: cardiac resynchronization therapy (P = .036) and HF education (P = .005) but not angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, β-blocker, aldosterone antagonist, implantable cardioverter-defibrillator therapy, and anticoagulation for atrial fibrillation.

Conclusions

Use of dedicated HF clinics varied in cardiology outpatient practices and was associated with greater use of cardiac resynchronization therapy and HF education but not other guideline-recommended therapies.