Faculty Articles
Impact of Treatment Guidelines on Clinical and Economic Outcomes of Acute Decompensated Heart Failure
Publication Title
The Annals of Pharmacotherapy
Publisher
Sage
ISSN
1060-0280
Publication Date
3-2008
Keywords
acute disease, aged, cohort studies, female, heart failure, hospitalization, humans, male, middle aged, practice guidelines as topic, retrospective studies, treatment outcome
Abstract
BACKGROUND: No data exist that demonstrate the impact of comprehensive acute decompensated heart failure (ADHF) treatment guidelines on clinical and economic outcomes in hospitalized patients with this condition.
OBJECTIVES: To compare clinical and economic outcomes before and after implementation of treatment guidelines for ADHF.
METHODS: A single-center, retrospective, chart review study was conducted in a university hospital. ADHF treatment guidelines were developed and implemented on January 1, 2004. Patients hospitalized for ADHF between January 2003 and November 2004 were identified using the Acute Decompensated Heart Failure Registry. Study periods were 12 months prior to and the 11 months following guideline implementation.
RESULTS: This cohort was comprised of 683 ADHF hospitalizations (357 preguideline, 326 postguideline); several patients were admitted more than once. There was a trend toward increased use of intravenous vasoactive drugs (VADs) following guideline implementation (19.9% vs 24.2%; p = 0.05). The duration of intravenous VAD use decreased by more than 40% following guideline implementation, but this was not statistically significant after risk adjustment (p = 0.22). The need for intensive care unit monitoring decreased from 45.1% before guideline implementation to 25.3% following guideline implementation (p < 0.02) in patients treated with intravenous VADs. The need for mechanical ventilation was reduced by nearly 80% (p = 0.04) following guideline implementation. Significantly more patients of the postguideline cohort were prescribed beta-blockers at discharge (54.9% vs 75.2%; p = 0.0001). Costs were not significantly different between the groups.
CONCLUSIONS: Implementation of ADHF treatment guidelines was associated with reduced need for mechanical ventilation, improved utilization of beta-blockers at discharge, and trends toward increased use of intravenous VADs, while not significantly changing total costs. More rigorous studies need to be conducted to estimate the true effect of treatment guidelines on ADHF care and outcomes.
DOI
10.1345/aph.1k496
Volume
42
Issue
3
First Page
327
Last Page
333
Disciplines
Medicine and Health Sciences | Pharmacy and Pharmaceutical Sciences
NSUWorks Citation
Didomenico, Robert J.; Perez Rivera, Alexandra; Schumann, Heather M.; Fontana, Dee R.; Kondos, George T.; and Schumock, Glen T., "Impact of Treatment Guidelines on Clinical and Economic Outcomes of Acute Decompensated Heart Failure" (2008). Faculty Articles. 27.
https://nsuworks.nova.edu/hpd_corx_facarticles/27
