Quality of care for patients hospitalized with heart failure at academic medical centers

Background The purpose of this study was to determine the standard of care provided by academic medical centers For the management of congestive heart failure (CHF). Methods and Results The standard of care was estimated by assessing adheren ce to the treatment guidelines published by the US Agency for Health Care P olicy and Research among 522 patients hospitalized at 7 university hospital s with a diagnosis of CHF. Data were abstracted by retrospective chart revi ew. Of the 522 patients analyzed, 435 (83%) had a left ventricular ejection fraction (LVEF) measured or documented. Among these patients, 192 were con sidered "ideal" candidates for angiotensin-converting enzyme (ACE) inhibito r therapy tie, with systolic dysfunction [LVEF <40%] and no contraindicatio ns to ACE inhibitors). In this cohort of "ideal" candidates, 138 (72%) were receiving ACE inhibitors at hospital discharge, including 60 (44%) who wer e prescribed doses recommended in large clinical trials. Compliance with pa tient education guidelines was assessed in all 487 patients who were alive at the time of discharge. Of these patients, 365 (75%) received dietary cou nseling, 404 (83%) were educated about exercise, 54 (11%) were instructed t o follow daily weights, and 468 (96%) were counseled regarding medication c ompliance. Among the 87 smokers who were alive at time of discharge, 8 (9%) had documented advice to quit smoking. Conclusions This study indicates that academic medical centers performed fa irly well on the assessment of LVEF, the prescription of ACE inhibitors at discharge, and on education regarding diet, exercise, and compliance with m edications. However, the results suggest opportunities for improvement in A CE inhibitor dosing and patient education regarding the importance of monit oring daily weights and smoking cessation.