Quality of congestive heart failure treatment at a Canadian teaching hospital

Background: Practice guidelines for the management of congestive heart fail ure (CHF) emphasize the need for assessment of left ventricular function an d treatment with angiotensin-converting enzyme (ACE) inhibitors. However, p revious studies have shown that many patients do not receive these tests or medications. The objective of this study was to evaluate the compliance of physicians at a large Canadian teaching hospital with published CHF manage ment guidelines. Methods: We conducted a retrospective review of the charts of 200 patients admitted to Sunnybrook & Women's College Health Sciences Centre, Toronto, i n 1997 for whom CHF was the diagnosis most responsible for the hospital adm ission. Quality of care was measured with 3 indicators: the use of left ven tricular function testing to determine systolic versus diastolic dysfunctio n; the prescription of ACE inhibitors to appropriate patients (those with s ystolic dysfunction, no contraindications to ACE inhibitor therapy and no a ngiotensin II receptor blocker use); and the prescription of target doses o f ACE inhibitors. Results: Of the 200 patients 177 (88.5 %) received left ventricular functio n testing before or during their hospital stay; of the 177, 117 (66.1 %) ha d systolic dysfunction. A total of 100 patients were considered to be ideal candidates for ACE inhibitor treatment. Of the 100, 89 (89.0 %) received A CE inhibitors; however, only 23 (23.0 %) were prescribed target doses. Interpretation: Most patients who had CHF at this Canadian hospital receive d left ventricular function testing and ACE inhibitor therapy. Future educa tional efforts should focus on the importance of adequate dosing of ACE inh ibitors.