Hospital performance measures intended to improve the quality of care for patients with heart failure have little bearing on mortality or rehospitalization, new research shows. Based on recommendations by the American College of Cardiology and the American Heart Association (ACC/AHA), these performance measures commonly include:
* discharge instructions
* evaluation of left ventricular function
* prescribing angiotensin-converting enzyme inhibitors or angiotensin receptor blockers
* encouraging smoking cessation
* prescribing anticoagulant therapy for patients with atrial fibrillation.
Researchers found that none of these measures were significantly associated with a reduced mortality risk within 60 to 90 days after hospital discharge. In contrast, they found that prescribing a beta-blocker at discharge was strongly associated with a reduced risk of death or rehospitalization. Prescribing beta-blockers isn't currently part of hospital performance measures for heart failure.
According to lead researcher Gregg C. Fonarow, MD, "Beta-blockers are the single most important life-prolonging therapy for patients with heart failure." He recommends incorporating beta-blocker therapy into hospital performance measures for patients with heart failure and calls for more research to identify other reliable performance measures.
Fonarow GC, et al., Association between performance measures and clinical outcomes for patients hospitalized with heart failure, JAMA, January 3, 2007.