Adhering to Heart Failure Treatment Guidelines More Important Than Volume, Study Finds

Looking at how well hospitals adhere to treatment guidelines for heart failure is more important than comparing patient volumes at hospitals, according to a recent study appearing in the American Heart Association (AHA) journal Circulation.

The study was based on records of more than 125,000 heart failure patients at 342 United States hospitals that were admitted between 2005 and 2014. Researchers were involved in the study from 7 different hospitals across the nation.

The scientists found that although volume didn’t solely affect mortality or readmission rates, hospitals that saw fewer heart failure patients were “significantly” less likely to follow AHA treatment guidelines.

“There’s a very small, incremental relationship between how many patients a hospital sees with heart failure and the actual patient outcome once you adjust for adherence to the guidelines. But we found that lower-volume hospitals have worse adherence to important heart failure processes than higher-volume hospitals,” lead author of the study, Dharam Kumbhani, MD, an interventional cardiologist at University of Texas (UT) Southwestern Medical Center, said in a statement.

According to the AHA, heart failure affects 6.5 million Americans.

Researchers found that hospitals treating fewer heart failure patients were less likely to utilize common treatment options such as:

• Prescribe beta-blockers or angiotensin converting enzyme inhibitors
• Run tests to check how well the heart’s left ventricle was pumping blood
• Install a defibrillator or cardiac resynchronization therapy (CRT) pacemaker

“Rather than directing patients to larger institutions, which can involve travel barriers and added costs, a better solution would be to find ways to give more hospitals easy access to treatment guidelines,” said Kumbhani.

Technology could help to enable greater provider access to treatment guidelines. According to the article, doctors at large metropolitan hospitals like UT Southwestern’s William P. Clements University Hospital have treatment guidelines on computer screens and readily available on smartphones that smaller hospitals may not be able to afford.

Researchers came to the conclusion that hospital profiling should focus more on healthcare improvement programs and adherence to treatment guidelines rather than on hospital volume alone.

References

Kumbhani D, Fonarow G, Heidenreich P, et al. Association between hospital volume, processes of care, and outcomes in patients admitted with heart failure: Insights from get with the guidelines- heart failure. Circ. 2018;117.028077. doi.org/10.1161/CIRCULATIONAHA.117.028077