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Effect of a Hospital and Postdischarge Quality Improvement Intervention on Clinical Outcomes and Quality of Care for Patients With Heart Failure With Reduced Ejection Fraction: The CONNECT-HF Randomized Clinical Trial.

Publication ,  Journal Article
DeVore, AD; Granger, BB; Fonarow, GC; Al-Khalidi, HR; Albert, NM; Lewis, EF; Butler, J; Piña, IL; Allen, LA; Yancy, CW; Cooper, LB; Felker, GM ...
Published in: JAMA
July 27, 2021

IMPORTANCE: Adoption of guideline-directed medical therapy for patients with heart failure is variable. Interventions to improve guideline-directed medical therapy have failed to consistently achieve target metrics, and limited data exist to inform efforts to improve heart failure quality of care. OBJECTIVE: To evaluate the effect of a hospital and postdischarge quality improvement intervention compared with usual care on heart failure outcomes and care. DESIGN, SETTING, AND PARTICIPANTS: This cluster randomized clinical trial was conducted at 161 US hospitals and included 5647 patients (2675 intervention vs 2972 usual care) followed up after a hospital discharge for acute heart failure with reduced ejection fraction (HFrEF). The trial was performed from 2017 to 2020, and the date of final follow-up was August 31, 2020. INTERVENTIONS: Hospitals (n = 82) randomized to a hospital and postdischarge quality improvement intervention received regular education of clinicians by a trained group of heart failure and quality improvement experts and audit and feedback on heart failure process measures (eg, use of guideline-directed medical therapy for HFrEF) and outcomes. Hospitals (n = 79) randomized to usual care received access to a generalized heart failure education website. MAIN OUTCOMES AND MEASURES: The coprimary outcomes were a composite of first heart failure rehospitalization or all-cause mortality and change in an opportunity-based composite score for heart failure quality (percentage of recommendations followed). RESULTS: Among 5647 patients (mean age, 63 years; 33% women; 38% Black; 87% chronic heart failure; 49% recent heart failure hospitalization), vital status was known for 5636 (99.8%). Heart failure rehospitalization or all-cause mortality occurred in 38.6% in the intervention group vs 39.2% in usual care (adjusted hazard ratio, 0.92 [95% CI, 0.81 to 1.05). The baseline quality-of-care score was 42.1% vs 45.5%, respectively, and the change from baseline to follow-up was 2.3% vs -1.0% (difference, 3.3% [95% CI, -0.8% to 7.3%]), with no significant difference between the 2 groups in the odds of achieving a higher composite quality score at last follow-up (adjusted odds ratio, 1.06 [95% CI, 0.93 to 1.21]). CONCLUSIONS AND RELEVANCE: Among patients with HFrEF in hospitals randomized to a hospital and postdischarge quality improvement intervention vs usual care, there was no significant difference in time to first heart failure rehospitalization or death, or in change in a composite heart failure quality-of-care score. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03035474.

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Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

July 27, 2021

Volume

326

Issue

4

Start / End Page

314 / 323

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Stroke Volume
  • Quality Indicators, Health Care
  • Quality Improvement
  • Patient Readmission
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Heart Failure
 

Citation

APA
Chicago
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DeVore, A. D., Granger, B. B., Fonarow, G. C., Al-Khalidi, H. R., Albert, N. M., Lewis, E. F., … Hernandez, A. F. (2021). Effect of a Hospital and Postdischarge Quality Improvement Intervention on Clinical Outcomes and Quality of Care for Patients With Heart Failure With Reduced Ejection Fraction: The CONNECT-HF Randomized Clinical Trial. JAMA, 326(4), 314–323. https://doi.org/10.1001/jama.2021.8844
DeVore, Adam D., Bradi B. Granger, Gregg C. Fonarow, Hussein R. Al-Khalidi, Nancy M. Albert, Eldrin F. Lewis, Javed Butler, et al. “Effect of a Hospital and Postdischarge Quality Improvement Intervention on Clinical Outcomes and Quality of Care for Patients With Heart Failure With Reduced Ejection Fraction: The CONNECT-HF Randomized Clinical Trial.JAMA 326, no. 4 (July 27, 2021): 314–23. https://doi.org/10.1001/jama.2021.8844.
DeVore AD, Granger BB, Fonarow GC, Al-Khalidi HR, Albert NM, Lewis EF, Butler J, Piña IL, Allen LA, Yancy CW, Cooper LB, Felker GM, Kaltenbach LA, McRae AT, Lanfear DE, Harrison RW, Disch M, Ariely D, Miller JM, Granger CB, Hernandez AF. Effect of a Hospital and Postdischarge Quality Improvement Intervention on Clinical Outcomes and Quality of Care for Patients With Heart Failure With Reduced Ejection Fraction: The CONNECT-HF Randomized Clinical Trial. JAMA. 2021 Jul 27;326(4):314–323.
Journal cover image

Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

July 27, 2021

Volume

326

Issue

4

Start / End Page

314 / 323

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Stroke Volume
  • Quality Indicators, Health Care
  • Quality Improvement
  • Patient Readmission
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Heart Failure