Hospital Quality Efforts Cut Heart Failure Deaths

Heart failure patients are less likely to die after they go home from the hospital if the hospital has participated in an organized quality improvement program, compared with patients treated at hospitals where such efforts aren't undertaken, a new study finds. They're also less likely to need another hospital stay.

Today at the Scientific Sessions meeting of the American Heart Association, University of Michigan Cardiovascular Center heart failure expert Todd Koelling, M.D., will present data from a two-year study involving more than 2,500 heart failure patients treated at 14 community hospitals in and around Flint, Mich.

Significantly lower death rates in the month after hospitalization were seen among those patients treated at eight hospitals that cooperated to find ways to deliver proven care and educate patients about their treatment, compared with six hospitals that didn't take part in the cooperative effort.

Rehospitalization rates also dropped, by 22 percent, when doctors and nurses used a "toolkit" of heart failure specific standard admission orders, in-patient clinical pathways, and discharge checklists to make sure that patients didn't miss out on treatments or counseling.

All patients in the study had heart failure, a chronic and disabling condition that affects 5 million Americans, mainly heart attack survivors and longtime high blood pressure patients. Heart failure is the most common heart-related cause of hospitalization in America, responsible for about 1 million hospital stays each year.

The new data echo the significant drops in mortality and complications that were achieved in a similar project in heart attack patients, a project also co-led by U-M heart specialists. Both projects are sponsored by the American College of Cardiology as part of its Guidelines Applied in Practice or GAP project, which seeks to ensure that all hospitalized heart patients receive proven treatments, counseling for lifestyle changes and education that can help them care for themselves after they go home.

U-M doctors have helped lead both projects, with help from MPRO, Michigan's healthcare quality improvement organization. The heart failure project, which grew out of the heart attack project, was spearheaded by the Greater Flint Health Coalition.

"To our knowledge, this is the first report that a community hospital quality-improvement program has resulted in meaningful improvement in heart failure mortality," says Koelling, associate professor of cardiovascular medicine. "The hospitals and health coalition should be commended because this was a cooperative fact-sharing, lesson sharing project among institutions that normally compete with one another. The winners from this cooperation are the patients."

Today at the Scientific Sessions meeting, Koelling will present the results on behalf of the hospitals and project manager Cecelia Montoye, MSN, a consultant to the ACC for both GAP projects. The data are from an analysis of medical records from the eight participating hospitals and six other hospitals in the Flint area that did not take part in the heart failure project, but had taken part in the heart attack project. Even though those hospitals were working to improve their heart failure care, their patients still had no changes in their 30-day mortality and rehospitalization rates.