Presentation is loading. Please wait.

Presentation is loading. Please wait.

A national initiative of the American Heart Association that provides healthcare professionals with content-rich resources and materials designed to help.

Similar presentations


Presentation on theme: "A national initiative of the American Heart Association that provides healthcare professionals with content-rich resources and materials designed to help."— Presentation transcript:

1

2 A national initiative of the American Heart Association that provides healthcare professionals with content-rich resources and materials designed to help advance heart failure awareness, prevention, and treatment. Target: Heart Failure 5/1/2015 ©2010, American Heart Association 2 Building on Success GWTG-Heart Failure Mission: Lifeline OPTIMIZE-HF Joint Commission/AHA Heart Failure Advanced Certification Program The Guideline Advantage

3 The Need 5/1/2015 ©2010, American Heart Association million Americans are currently living with heart failure, and 670,000 new cases are diagnosed each year- up significantly from 500,000 cases annually just a few years ago. As our population ages, this epidemic of heart failure will only continue to grow. The cost of providing heart failure ranks among the leading U.S. healthcare expenditures. Additionally, the toll of heart failure on life, both in quality and longevity, is sobering.

4 A national initiative of the American Heart Association that provides healthcare professionals with content-rich resources and materials designed to help advance heart failure awareness, prevention, and treatment. What is Target: Heart Failure ? 5/1/2015 ©2010, American Heart Association 4

5 5/1/2015 ©2010, American Heart Association 5 Target: Heart Failure Vision: To improve quality, care transitions, and outcomes for patients with heart failure with a targeted initiative and leveraging the American Heart Association’s premier quality improvement suite of resources including Get With The Guidelines-Heart Failure.

6 5/1/2015 ©2010, American Heart Association 6 Target: Heart Failure Mission: Increase 3 key patient-centered care domains with very well established or emerging evidence-base: Medication optimization Early follow-up and care coordination Enhanced patient education

7 Target: HF Optimal Care Transitions and Patient Education: 5/1/2015 ©2010, American Heart Association 7 Discharge use of ACEI/ARB, evidence-based beta blocker, and aldosterone antagonist in all eligible heart failure patients with reduced LVEF, in absence of documented contraindications, intolerance, or patient/system reasons Early post-discharge follow-up with visit or contact within 48 hours of discharge scheduled Enhanced patient education as evidenced by referral to heart failure disease management program, provision of at least 60 minutes of heart failure education by a qualified heart failure educator, or provision of AHA heart failure interactive workbook

8 5/1/2015 ©2010, American Heart Association 8 Building on Success GWTG-Heart Failure Mission: Lifeline Joint Commission/AHA Heart Failure Advanced Certification OPTIMIZE-HF The Guideline Advantage

9 Background on Heart Failure Heart failure (HF) is a major public health problem resulting in substantial morbidity and mortality Despite recent advances a substantial number of patients are not receiving optimal care 2 Jones DL et al. Heart Disease and Stroke Statistics 2011 Update. Report from the AHA. Circulation Population GroupPrevalenceIncidenceMortality Hospital DischargesCost Total population 5,700,000670,000277,193990,000 $39.2 billion 9

10 Heart Failure Hospitalizations United States: Source: NHDS/NCHS, NHLBI. Hospital Compare The majority of patients hospitalized with HF were previously hospitalized with HF 1.0 Million Hospitalizations a Year and Rising 30-Day Rehospitalization Rates in HF 24.8% (Medicare) 10

11 30-Day Rehospitalization Rates in HF Vary Widely Between Hospitals Keenan PS et al. Circ Cardiovasc Qual Outcomes. 2008;1: X axis, hospital decile, 0-9 Y axis, mean hospital observed rates for 30-day rehospitalization from 0 to.40

12 All-Cause Mortality After Each Subsequent Hospitalization for HF Time since admission Cumulative mortality HF 1 st admission (n = 14,374) 2 nd admission (n = 3,358) 3 rd admission (n = 1,123) 4 th admission (n = 417) 1 st hospitalization: 30-day mortality = 12%; 1-year mortality = 34% Setoguchi S, et al. Am Heart J. 2007;154: P<

13 Estimated Direct and Indirect Costs of HF in US 10.5% 9.7% 8.2% 6.4% 11.9% 53.3% Hospitalization $20.9 Lost Productivity/ Mortality* $4.1 Home Healthcare $3.8 Drugs/Other Medical Durables $3.2 Physicians/Other Professionals $2.5 Nursing Home $4.7 Heart Disease and Stroke Statistics—2010 Update: A Report From the American Heart Association Circulation, Feb 2010; 121: e46 - e215. Total Cost $39.2 billion 13

14 Causes of Hospital Readmission for Heart Failure 17% Other 19% Failure to Seek Care 16% Inappropriate Rx Rx Noncompliance 24% Diet Noncompliance 24% Annals of Internal Medicine 122:415-21, 1995 Over 2/3 of HF Hospitalizations Preventable 14

15 Measuring and Improving the Quality of HF Care Heart failure remains a major public health problem resulting in substantial morbidity and mortality. A number of evidence-based, guideline-recommended therapies are available to treat patients with heart failure. However, study after study shows the large gaps, variations, and disparities in the use of these evidence based therapies in eligible patients. 15

16 ADHERE Quality of Care Conformity to The Joint Commission HF Performance Indicators Fonarow GC et al. Arch Intern Med 2005;165: Lagging CentersLeading Centers admissions between 6/2002 – 12/2003 at 223 hospitals Grouped by Leading (90 th percentile) and Lagging (10 th percentile) All P< Discharge Instructions LV Function Measurement ACEI use Smoking Cessation % Utilization Length of Stay (median) Mortality 16

17 Risk-Treatment Mismatch in HF: Canadian EFFECT Study Use rates in absence of contraindications. For all drug classes, P <.001 for trend. EFFECT, Enhanced Feedback for Effective Cardiac Treatment. Lee D. JAMA. 2005;294: At Hospital Discharge90-Day Follow-Up1-Year Follow-Up Low RiskAverage RiskHigh Risk ACEIACEI or ARB  - Blocker 1-Year Mortality Rate Patients, % ACEIACEI or ARB  - Blocker 17

18 Evidence-Based Treatment for Heart Failure with Reduced LVEF Control Volume Reduce Mortality Sodium Restriction* Diuretics* Digoxin*  -Blocker ACEI or ARB Aldosterone Antagonist Treat Residual Symptoms CRT  an ICD* Hyd/ISDN* *For select indicated patients. ICD* Treat Comorbidities Aspirin* Warfarin* Statin* Enhance Adherence Education Disease Management Performance Improvement Systems 18

19 Established Benefits of Guideline-Recommended HF Therapies Fonarow GC, et al. Am Heart J 2011;161: Guideline Recommended Therapy Relative Risk Reduction in Mortality Number Needed to Treat for Mortality NNT for Mortality (standardized to 36 months) Relative Risk Reduction in HF Hospitalizations ACEI/ARB17%22 over 42 months2631% Beta-blocker34%28 over 12 months941% Aldosterone Antagonist 30%9 over 24 months635% Hydralazine/Nitrate43%25 over 10 months733% CRT36%12 over 24 months852% ICD23%14 over 60 months23NA

20 Improved Adherence to ACC/AHA HF Guidelines Translates to Improved Clinical Outcomes in Real World HF Patients Each 10% improvement in ACC/AHA guideline- recommended composite care was associated with a 13% lower odds of 24-month mortality (adjusted OR 0.87; 95% CI, 0.84 to 0.90; P<0.0001). Fonarow GC, et al. Circulation. 2011;123:

21 Adapted from the American Heart Association. Get With The Guidelines; Implement evidence-based care Improve communications Ensure compliance Systems Clinical Practice ACC/AHA/HFSA Guidelines Improve quality of care Improve outcomes Clinical trial evidence National guidelines Bridging the Gap Between Knowledge and Routine Clinical Practice 20

22 ACC/AHA 2005 HF Guidelines: Implementation of Guidelines Academic detailing or educational outreach visits are useful to facilitate the implementation of practice guidelines Multidisciplinary disease-management programs for patients at high risk for hospital admission or clinical deterioration are recommended Chart audit and feedback of results can be effective to facilitate implementation of practice guidelines The use of reminder systems can be effective to facilitate implementation of practice guidelines The use of performance measures based on practice guidelines may be useful to improve quality of care Hunt SA, et al. ACC/AHA 2005 Practice Guidelines. Available at 21

23 American Heart Association’s Get With the Guidelines–Heart Failure The AHA’s hospital based quality-improvement program aims at ensuring that every patient with HF receives the best possible care Continuity of data and hospital tools with OPTIMIZE-HF Launched January 2005; currently over 500 US hospitals participating, over 500,000 patient HF hospitalizations Opportunity for hospitals to achieve national recognition through participation Opportunity for advanced heart failure certification via The Joint Commission 22

24 May 2011 GWTG-HF Performance Measures Data from 458 GWTG-HF hospitals and 481,098 HF hospitalizations collected from 1/1/05-12/31/10 All p<

25 May 2011 GWTG-HF Performance Measures Data from 458 GWTG-HF hospitals and 481,098 HF hospitalizations collected from 1/1/05-12/31/10 All p<

26 May 2011 Data from 458 GWTG-HF hospitals and 481,098 HF hospitalizations collected from 1/1/05-12/31/10 GWTG-HF Performance Measures All p<

27 GWTG-HF Participation and Quality of Care for Heart Failure Heidenreich PA et al Am Heart J 2009;158: MeasureGWTG Hospitals (n=355) Non-GWTG Hospitals (n=3909) P-Value LVEF documented92.8%83.0%< ACEI/ARB in LVSD85.6%81.4%0.001 Discharge Instructions 67.7%55.3%<0.001 Smoking Cessation Counseling 85.7%81.3%0.04

28 Impact of Evidence-Based HF Therapy Use at Hospital Discharge on Treatment Rates During Follow-Up  -Blocker at Discharge YES  -Blocker at Discharge NO ACEI/ARB at Discharge YES ACEI/ARB at Discharge NO (1,579/1,697) (94/309)(1,329/1,861)(75/382) 60- to 90-Day Postdischarge Follow-Up OR 30.6 (95% CI, ) P .0001 OR (95% CI ) P .0001 Fonarow GC et al. J Card Fail 2007;13:

29 Impact of Discharge Use of Beta Blocker on Early Clinical Outcomes in Heart Failure *Only subset of patients with 60- to 90-day follow-up are included. Patients with beta-blocker contraindications are excluded. Survival Probability Patients at Risk Beta-blocker1,9461,8551, No Beta-blocker Days After Hospital Discharge Beta-BlockerNo Beta-Blocker P= Fonarow et al. J Am Coll Cardiol. 2008;52: day Survival P<

30 In-Hospital and Follow-Up Outcomes Improve When Process of Care Tools are Used: OPTIMIZE-HF P .001 PrCI Tool Use No PrCI Tool Use PrCI Tool Use No PrCI Tool Use P<.02 Patients (%) Process of care tool use (admission order set or discharge checklist) was reported during hospitalization in 45.3% of patients (n=22,017/48,612) Fonarow GC, et al. Arch Intern Med. 2007;167:1493  In-Hospital Mortality 60- to 90-Day Mortality and Rehospitalization 28

31 5/1/2015 ©2010, American Heart Association 31

32 With few exceptions, individual HF core measures were similar for Black, Hispanic, and White patients. When there were differences in core measures, they predominantly favored nonwhite subgroups GWTG-HF Results in Equitable Care Unadjusted Thomas K et al. Am Heart J. 2011;161:

33 GWTG-HF Resulted in Equitable Improvement by Race/ Ethnicity in HF Quality Trends in “All-or-None HF Care Measure* by Race/Ethnicity Unadjusted Odds Ratio Adjusted** Odds Ratio White (Year 1 vs. Baseline) White (Year 2 vs. Baseline) White (Year 3 vs. Baseline) Black (Year 1 vs. Baseline) Black (Year 2 vs. Baseline) Black (Year 3 vs. Baseline) Hispanic (Year 1 vs. Baseline) Hispanic (Year 2 vs. Baseline)2.00 Hispanic (Year 3 vs. Baseline) *”All-or-None HF Care Measure” = 100% adherence to al 4 HF care measures plus B-Blocker use in patients with LV systolic dysfunction **Adjusted variables include age, gender, body mass index, insurance, medical history, systolic blood pressure and hospital characteristics Thomas K et al. Am Heart J. 2011;161:

34 Hospital Variation in Early Follow-up After Heart Failure Hospitalization Median Follow-up Visit within 7 days = 37.5% 225 Hospitals Hernandez et al. JAMA 2010;303:

35 Hospital Variation in Early Follow-up After HF Hospitalization: Follow-up by Physician Type Hernandez et al. JAMA 2010;303:

36 30-Day Mortality p= Day Readmission p <0.01 Hernandez et al. JAMA 2010;303: Relationship Between Early Physician Follow-up and 30-day Outcomes for Medicare Beneficiaries

37 Relationship Between Early Physician Follow-up and 30-day Readmission Among Medicare Beneficiaries Hospitalized for HF Early Follow-up Unadjusted HR 95% CI P Value Adjusted HR 95% CI P Value Quartile 11.0 (REF) Quartile < <01 Quartile < <01 Quartile < Hernandez et al. JAMA 2010;303: Hospitals in the lowest quartile of early physician follow-up had higher rates of rehospitalization within 30-days, than those in the other 3 quartiles, independent of other factors

38 Rehospitalizations in Heart Failure Nearly one in four patients hospitalized with HF is rehospitalized within 30 days of discharge Opportunity to Improve 30-day rates of rehospitalizations in HF have risen over the past 2 decades and vary widely by hospital, even after adjusting for case mix and other factors Opportunity to Improve Many HF hospitalizations are preventable, but effective strategies to prevent rehospitalizations are underutilized Opportunity to Improve 34

39 Over 60 heart failure tools, including:  Discharge Orders/Instructions  Order Sets  Pathways/Algorithms  Patient Education Materials  Other Tools All posted submissions were reviewed/evaluated by AHA volunteer workgroup. AHA does not endorse any tools. Submissions are intended solely as examples that hospitals may want to consider using/modifying. Heart failure clinical tools library: heart.org/hfclinicaltools.heart.org/hfclinicaltools Stroke clinical tools library: heart.org/strokeclinicaltools.heart.org/strokeclinicaltools Submit tools you would like us to consider to Get With The Guidelines ® Heart Failure Clinical Tools Library 37

40 AHA Interactive Workbook to help educate patients and help them manage Heart Failure. Created for after the patients hospital stay, the interactive workbook focuses on preventing recurring events. The workbook helps improve patient health and track recovery. These workbook are designed to help the patient better understand their condition, how to maximize their recovery and provide the skills to the patient and their caregivers need to better manage heart failure.

41 Challenges to Implement a HF Performance Improvement System This will not work in a community practice or hospital. The cardiologists will not agree to this. We can not get a consensus. The managed care organization will not pay for it. Patients do not want to be on a lot of medications. There is not enough time. It will cost too much. It may not be safe to start Beta Blocker medications in heart failure patients. This will benefit the competition. The administration will not pay for it. What about the liability? It will take too much time. All my patients are too complex for this. The patients should all be followed by someone else. It is too hard to get things through the practice committee. The physicians at my office do not like cookbook medicine. We do not have anyone to do this. 38

42 Bradley. JAMA. 2001;285: Key Elements to Quality Improvement: Why Do Some Programs Succeed? Access to current and accurate data on treatment and outcomes Have stated goals Administrative support Support among clinicians Use of care maps and pathways Use of data to provide feedback 39

43 Potential Impact of Optimal Implementation of Evidence-Based HF Therapies on Mortality Fonarow GC, et al. Am Heart J 2011;161: Guideline Recommended Therapy HF Patient Population Eligible for Treatment, n* Current HF Population Eligible and Untreated, n (%) Potential Lives Saved per Year (Sensitivity Range*) ACEI/ARB2,459,644501,767 (20.4)6516( ,260) Beta-blocker2,512,560361,809 (14.4)12,922( ,329) Aldosterone Antagonist603,014385,326 (63.9)21,407(10,960-36,991) Hydralazine/Nitrate150,754139,749 (92.7)6655( ,500) CRT326,151199,604 (61.2)8317( ,372) ICD1,725,732852,512 (49.4)12,179( ,045) Total--67,996(34, ,497)

44 Target: Heart Failure Honor Roll Recognition 5/1/2015 ©2010, American Heart Association 44 Requirements: Documentation of all three care components for 50% or more of eligible patients with heart failure discharged to home. Hospitals must be GWTG-HF performance achievement award hospitals.

45 Target: Heart Failure Resources 5/1/2015 ©2010, American Heart Association Get With The Guidelines-Heart Failure Patient Management Tool™ Get With The Guidelines Heart Failure Tool Kit AHA patient education resources Heart Failure Best Practices Center Heart Failure Interactive Patient Education Workbook Heart Failure guidelines, publications, and resources Heart

46 For more information and to register for Target: Heart Failure, go to 5/1/2015 ©2010, American Heart Association 46


Download ppt "A national initiative of the American Heart Association that provides healthcare professionals with content-rich resources and materials designed to help."

Similar presentations


Ads by Google