Table 20-2.

Heart Failure Quality-of-Care Measures, 2009

Quality-of-Care Measure	National Medicare and Medicaid	AHA- GWTG-HF	VHA
LVEF assessment	97	98*	100
ARB/ACEI at discharge for patients with left ventricular systolic dysfunction	93	93*	96
Complete discharge instructions	85	91*	96
Adult smoking cessation advice/counseling	98	98*	98
β-blockers at discharge for patients with LVSD, no contraindications	NM	93*	90
Anticoagulation for AF or atrial flutter, no contraindications	NM	69	94

AHA GWTG-HF indicates American Heart Association Get With The Guidelines–Heart Failure; VHA, Veterans Health Administration; LVEF, left ventricular ejection fraction; ARB, angiotensin receptor blocker; ACEI, angiotensin-converting enzyme inhibitor; LVSD, left ventricular systolic dysfunction; NM, not measured; AF, atrial fibrillation.

Values are percentages.

In the GWTG registry, mechanical ventilation was required in 3.0% of patients. In-hospital mortality rate was 3.0%, and mean length of hospital stay was 5.5 days (median 4.0 days).

^*Indicates the 5 key performance measures targeted in GWTG-HF. The composite quality-of-care measure for 2009 was 94.5%. The composite quality-of-care measure indicates performance on the provision of several elements of care. It is computed by summing the numerators for each key performance measure across the population of interest to create a composite numerator (all the care that was given), summing the denominators for each measure to form a composite denominator (all the care that should have been given), and reporting the ratio (the percentage of all the needed care that was given).