Veterans affairs quality enhancement research initiative in chronic heart failure

Chronic heart failure (CHF) is a highly prevalent condition associated with serious morbidity, intense levels of health services use, and shortened su rvival. It is also a condition for which ameliorative therapies exist. The evidence indicates that there is substantial need to change clinical practi ce and health care delivery for people with CHF and thereby improve their o utcomes. The goal of the Veterans Affairs (VA) Quality Enhancement Research Initiative in CHF (CHF QUERI) is to create measurable, rapid, and sustaina ble improvements in quality of care and health outcomes of veterans with he art failure. This article describes the current state of knowledge and prac tice in fare for people with CHF. Using the framework of the 5 steps of the QUERI process, we point out the gaps in research and practice that must be filled if the CHF QUERI is to achieve its goal. We relate our recommendati ons for how the VA can put its research and administrative infrastructure t o work to fill the gaps. Lessons learned about CHF in the course of the CHF QUERI will be applicable to all people with heart failure and to all healt h care systems-VA as well as non-VA-that care for them.