Quality of care of patients hospitalized with congestive heart failure

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Abstract
Background: Congestive heart failure (CHF) is an increasingly prevalent poor‐prognosis condition for which effective interventions are available. It is ­therefore important to determine the extent to which patients with CHF receive appropriate care in Australian hospitals and identify ways for improving suboptimal care, if it exists. Aim: To evaluate the quality of in‐hospital acute care of patients with CHF using explicit quality indicators based on published guidelines. Methods: A retrospective case note review was ­performed, involving 216 patients admitted to three teaching hospitals in Brisbane, Queensland, Australia, between October 2000 and April 2001. Outcome measures were process‐of‐care quality ­indicators calculated as proportions of all, or strongly ­eligible (ideal), patients who received ­specific interventions. Results: Assessment of underlying causes and acute precipitating factors was undertaken in 86% and 76% of patients, respectively, and objective evaluation of left ventricular function was performed in 62% of patients. Prophylaxis for deep venous thrombosis (DVT) was used in only 29% of ideal patients. Proportions of ideal patients receiving pharmacological treatments at discharge were: (i) angiotensin‐­converting enzyme inhibitors (ACEi) (82%), (ii) target doses of ACEi (61%), (iii) alternative vasodilators in patients ineligible for ACEi (20%), (iv) β‐blockers (40%) and (v) warfarin (46%). Conclusions: Opportunities exist for improving quality of in‐hospital care of patients with CHF, ­particularly for optimal prescribing of: (i) DVT prophylaxis, (ii) ACEi, (iii) second‐line vasodilators, (iv) β‐blockers and (v) warfarin. More research is needed to identify methods for improving quality of in‐hospital care. (Intern Med J 2003; 33: 140−151)

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