TABLE 7.
Summary of performance indicators for heart failure (HF) by development group
| Indicator | CCORT inpatient (157) | CCORT outpatient (157) | Canadian primary care (196) | AHA/ACC inpatient (158) | AHA/ACC outpatient (158) | JCAHO (159) | OPTIMIZE-HF (176) | ACOVE (160) | IMPROVE HF (179,180) |
|---|---|---|---|---|---|---|---|---|---|
| Therapeutics | |||||||||
| ACEi and/or ARB if LV systolic dysfunction in eligible patients | x | x | x | x | x | x | x | x | x |
| Use of beta-blockers (evidence based or not) in eligible patients | x | x | x | x | x | x | x | x | |
| Use of statins in eligible patients if underlying CAD, PVD, CVD or diabetes | x | ||||||||
| Aldosterone antagonists for eligible patients | x | x | x | ||||||
| Anticoagulants for atrial fibrillation | x | x | x | x | x | x | |||
| Use of ICD in eligible patients | x | ||||||||
| Use of CRT in eligible patients | x | ||||||||
| Avoid 1st and 2nd generation CCBs if LV systolic dysfunction | x | ||||||||
| Avoid type 1 antiarrhythmic agents if LV systolic dysfunction (unless ICD in place) | x | ||||||||
| Investigations | |||||||||
| Outpatient assessment including one or more of regular volume assessment, weight, blood pressure, activity level | x | x | x | x | |||||
| Appropriate baseline blood/urine tests, ECG, CXR | x | x | |||||||
| Appropriate biochemical monitoring of renal function and electrolytes | x | x | x | ||||||
| Assessment of LV function | x | x | x | x | x | x | x | x | x |
| Measure digoxin levels if toxicity suspected | x | ||||||||
| Education and follow-up | |||||||||
| HF patient education/discharge instructions | x | x | x | x | x | x | x | ||
| Outpatient follow-up within 4 weeks | x | ||||||||
| Advice on smoking cessation | x | x | x | ||||||
Please refer to primary references for specific details regarding inclusion and exclusion criteria, and implantation requirements for each quality indicator. ACEi Angiotensin-converting enzyme inhibitor; ACOVE Assessing the Care of Vulnerable Elders Project; AHA/ACC American Heart Association/American College of Cardiology; ARB Angiotensin Receptor Blocker; CAD Coronary artery disease; CCB Calcium channel blocker; CCORT Canadian Cardiovascular Outcomes Research Team; CRT Cardiac resynchronization therapy; CVD Cerebrovascular disease; CXR Chest x-ray; ECG Electrocardiogram; ICD Implantable cardioverter defibrillator; IMPROVE HF Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting; JCAHO Joint Commission on Accreditation of Healthcare Organizations; LV Left ventricle; OPTIMIZE-HF Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure; PVD Peripheral vascular disease