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patient and practice factors associated with improvement in use of guideline-recommended therapies for outpatients with heart failure (from the IMPROVE HF trial).

Publication ,  Journal Article
O'Connor, CM; Albert, NM; Curtis, AB; Gheorghiade, M; Heywood, JT; McBride, ML; Inge, PJ; Mehra, MR; Reynolds, D; Walsh, MN; Yancy, CW; Fonarow, GC
Published in: Am J Cardiol
January 15, 2011

Diverse factors are associated with variations in evidence-based treatment of outpatients with heart failure (HF). However, patient and practice characteristics associated with improved use of guideline-recommended therapies over time have not been well studied. The Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) is a prospective evaluation of a performance improvement initiative conducted at 167 practices treating outpatients with diagnosed HF or previous myocardial infarction and left ventricular ejection fraction ≤35%. Patient characteristics and care practice data were collected by chart abstraction at baseline and 24 months for 14,236 patients. Seven individual care measures and a composite measure were assessed. Practices were stratified by tertiles of composite measure improvement, and significant, independent patient and practice factors associated with improvement in the composite measure at 24 months were examined. The baseline composite performance measure was 68.4%, which increased to 80.1% at 24 months (+11.6%, p <0.001). The composite measure improvement tertiles were ≤8%, >8% to 15%, and >15%. Multivariate analyses revealed greater improvements associated only with lower practice baseline composite measure rates (p <0.001). Logistic regression showed that 2 additional variables were inversely associated with practices in the highest tertile in composite measure improvement (>15%): southern practice location (p = 0.0239) and edema (p = 0.0047). In conclusion, few patient and practice factors were associated with greater or lesser overall improvements over time in the use of guideline-recommended HF therapies. Other factors may be more important determinates of the magnitude of care improvements over time among cardiology practices participating in a performance improvement initiative.

Duke Scholars

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

January 15, 2011

Volume

107

Issue

2

Start / End Page

250 / 258

Location

United States

Related Subject Headings

  • United States
  • Prospective Studies
  • Practice Guidelines as Topic
  • Outpatients
  • Outcome Assessment, Health Care
  • Male
  • Humans
  • Heart Failure
  • Guideline Adherence
  • Follow-Up Studies
 

Citation

APA
Chicago
ICMJE
MLA
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O’Connor, C. M., Albert, N. M., Curtis, A. B., Gheorghiade, M., Heywood, J. T., McBride, M. L., … Fonarow, G. C. (2011). patient and practice factors associated with improvement in use of guideline-recommended therapies for outpatients with heart failure (from the IMPROVE HF trial). Am J Cardiol, 107(2), 250–258. https://doi.org/10.1016/j.amjcard.2010.09.012
O’Connor, Christopher M., Nancy M. Albert, Anne B. Curtis, Mihai Gheorghiade, J Thomas Heywood, Mark L. McBride, Patches Johnson Inge, et al. “patient and practice factors associated with improvement in use of guideline-recommended therapies for outpatients with heart failure (from the IMPROVE HF trial).Am J Cardiol 107, no. 2 (January 15, 2011): 250–58. https://doi.org/10.1016/j.amjcard.2010.09.012.
O’Connor CM, Albert NM, Curtis AB, Gheorghiade M, Heywood JT, McBride ML, et al. patient and practice factors associated with improvement in use of guideline-recommended therapies for outpatients with heart failure (from the IMPROVE HF trial). Am J Cardiol. 2011 Jan 15;107(2):250–8.
O’Connor, Christopher M., et al. “patient and practice factors associated with improvement in use of guideline-recommended therapies for outpatients with heart failure (from the IMPROVE HF trial).Am J Cardiol, vol. 107, no. 2, Jan. 2011, pp. 250–58. Pubmed, doi:10.1016/j.amjcard.2010.09.012.
O’Connor CM, Albert NM, Curtis AB, Gheorghiade M, Heywood JT, McBride ML, Inge PJ, Mehra MR, Reynolds D, Walsh MN, Yancy CW, Fonarow GC. patient and practice factors associated with improvement in use of guideline-recommended therapies for outpatients with heart failure (from the IMPROVE HF trial). Am J Cardiol. 2011 Jan 15;107(2):250–258.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

January 15, 2011

Volume

107

Issue

2

Start / End Page

250 / 258

Location

United States

Related Subject Headings

  • United States
  • Prospective Studies
  • Practice Guidelines as Topic
  • Outpatients
  • Outcome Assessment, Health Care
  • Male
  • Humans
  • Heart Failure
  • Guideline Adherence
  • Follow-Up Studies