Skip to main content
NCBI home page
Clinical Cardiology logoLink to Clinical Cardiology
. 2006 Dec 5;26(5):231–237. doi: 10.1002/clc.4960260507

Opportunities for improvement in the diagnosis and treatment of heart failure

Peter A McCullough 1,✉, Edward F Philbin 2, John A Spertus 3, Keisha R Sandberg 4, Roberta A Sullivan 1, Scott Kaatz 5
PMCID: PMC6654399  PMID: 12769251

Abstract

Background: Improved treatment of congestive heart failure (CHF) can slow disease progression, promote clinical stability, and prolong survival.

Hypothesis: Patterns in diagnostic test utilization and pharmacotherapy among patients with newly diagnosed heart failure may affect outcomes.

Methods: Claims data were analyzed from all diagnostic procedures and prescriptions from 1995 to 1998 in 3,353 patients with heart failure diagnosed within 1 year. Rates of diagnostic testing and categories of drugs prescribed were the main outcome measures. Demographic variables and type of provider were analyzed within a setting whose access to care was controlled.

Results: Rates of diagnostic testing with respect to basic, metabolic/endocrine, alternative diagnoses, underlying ischemia, and left ventricular function varied as a function of gender, age, race, and primary versus specialty care provider. Only 4.7% of patients underwent all diagnostics and treatments recommended in current guidelines. However, those patients (27.5%) who underwent an evaluation for ischemic heart disease and were prescribed vasodilators or beta blockers enjoyed the lowest crude mortality.

Conclusions: There are multiple opportunities apparent to improve the initial diagnostic and therapeutic care of patients with heart failure. There appears to be an early survival benefit with respect to use of vasodilators and beta blockers within the first year of treatment.

Keywords: heart failure, diagnostic testing, pharmacotherapy, mortality, primary care, health services research

Full Text

The Full Text of this article is available as a PDF (211.6 KB).

References

  • 1. Graves EJ: Washington DC: U. S. Department of Health and Human Services, detailed diagnoses and procedures, national hospital discharge survey, 1990. National Center for Health Statistics, Vital and Health Statistics 1991 (Series 13, No. 113, DHHS Publ. No. [PHS] 92–1774) [PubMed]
  • 2. Hoes AW, Mosterd A, Grobbee DE: An epidemic of heart failure? Recent evidence from Europe. Eur Heart J 1998; 19 (suppl L): L2–9 [PubMed] [Google Scholar]
  • 3. Ranofsky AL: Inpatient utilization of short‐stay hospitals by diagnosis. Washington DC: U. S. Department of Health, Education, and Welfare, National Center for Health Statistics, Vital and Health Statistics 1974. (Series 13, No. 16, DHEW Publ. No. [HRA] 75–1767)
  • 4. Parameshwar J, Shackell MM, Richardson A, Poole‐Wilson PA, Sutton GC: Prevalence of heart failure in three general practices in Northwest London. Br J Gen Pract 1992; 42: 287–289 [PMC free article] [PubMed] [Google Scholar]
  • 5. Kannel WB, Ho K, Thom T: Changing epidemiological features of cardiac failure. Br Heart J 1994; 72 (2 suppl): S3–9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6. Schocken DD, Arrieta MI, Leaverton PE, Ross EA: Prevalence and mortality rate of congestive heart failure in the United States. J Am Coll Cardiol 1992; 20: 301–306 [DOI] [PubMed] [Google Scholar]
  • 7. Schocken DD, Sharma K, Schwartz S, Leaverton PE: Population‐based prevalence and mortality of heart failure in the United States: Data from NHANES II with 12–16 year follow‐up. Circulation 1999; 100:I–2080 [Google Scholar]
  • 8. Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK: The progression from hypertension to congestive heart failure. J Am Med Assoc 1996; 275: 1557–1562 [PubMed] [Google Scholar]
  • 9. Ho KK, Pinsky JL, Kannel WB, Levy D: The epidemiology of heart failure: The Framingham Study. J Am Coll Cardiol 1993; 22 (4 suppl A): 6A–13A [DOI] [PubMed] [Google Scholar]
  • 10. Philbin EF, McCullough PA, Polanczyk CA: Are subjects in heart failure trials similar in clinical practice? (abstr). Circulation 1998; 98:I–866 [Google Scholar]
  • 11. McCullough PA, Philbin EF, Spertus JA, Kaatz S, Sandberg KR, Weaver WD: Confirmation of a heart failure epidemic: Findings from the Resource Utilization Among Congestive Heart Failure (R. E. A. C. H.) Study. J Am Coll Cardiol 2002; 39 (1): 60–69 [DOI] [PubMed] [Google Scholar]
  • 12. Demers RY, Chapman RA, Flasch MH, Martin C, McCarthy BD, Nelson S: The Henry Ford Health System. Cancer 1998; 82: 2043–2046 [DOI] [PubMed] [Google Scholar]
  • 13. U. S. Health Care Financing Administration : Diagnosis Related Groups Definitions Manual. Wallingford, Conn.: 3M Health Information Services, 1993. [Google Scholar]
  • 14. Philbin EF, Rocco TA, Lindenmuth NW, Ulrich K, Jenkins PL: Clinical outcomes in heart failure: Report from a community hospital‐based registry. Am J Med 1999; 107: 549–555 [DOI] [PubMed] [Google Scholar]
  • 15. Zannad F, Braincon S, Juillière Y, Mertes PM, Villemot JP, Alla F, Virion JM: Incidence, clinical and etiologic features, and outcomes of advanced chronic heart failure: The EPICAL Study. Epidemiologie de l'Insuffisance Cardiaque Avancée en Lorraine. J Am Coll Cardiol 1999; 33: 734–742 [DOI] [PubMed] [Google Scholar]
  • 16. Cowie MR, Mosterd A, Wood DA, Deckers JW, Poole‐Wilson PA, Sutton GC, Grobbee DE: The epidemiology of heart failure. Eur Heart J 1997; 18: 208–225 [DOI] [PubMed] [Google Scholar]
  • 17. Ho KK, Anderson KM, Kannel WB, Grossman W, Levy D: Survival after the onset of congestive heart failure in Framingham Heart Study subjects. Circulation 1993; 88: 107–115 [DOI] [PubMed] [Google Scholar]
  • 18. Spencer FA, Meyer TE, Goldberg RJ, Yarzebski J, Hatton M, Lessard D, Gore JM: Twenty year trends (1975–1995) in the incidence, in‐hospital and long‐term death rates associated with heart failure complicating acute my‐ocardial infarction: A community‐wide perspective. J Am Coll Cardiol 1999; 34: 1378–1387 [DOI] [PubMed] [Google Scholar]
  • 19. Polanczyk CA, Rohde LE, Dec GW, DiSalvo T: Ten‐year trends in hospital care for congestive heart failure: Improved outcomes and increased use of resources. Arch Intern Med 2000; 160: 325–332 [DOI] [PubMed] [Google Scholar]
  • 20. Evaluation and Care of Patients with Left‐Ventricular Systolic Dysfunction. Clinical Practice Guideline Number 11. AHCPR Publication No. 94–0612: June 1994.
  • 21. Hunt SA, Baker DW, Chin MH, Cinquegrani MP, Feldman AM, Francis GS, Ganiats TG, Goldstein S, Gregoratos G, Jessup ML, Noble RJ, Packer M, Silver MA, Stevenson LW, Gibbons RJ, Antman EM, Alpert JS, Faxon DP, Fuster V, Jacobs AK, Hiratzka LF, Russell RO, Smith SC Jr, American College of Cardiology/American Heart Association: ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: Executive summary. A report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee to revise the 1995 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol 2001; 38 (7): 2101–2113 [DOI] [PubMed] [Google Scholar]
  • 22. Krumholz HM, Baker DW, Ashton CM, Dunbar SB, Friesinger GC, Havranek EP, Hlatky MA, Konstam M, Ordin DL, Pina IL, Pitt B, Spertus JA: Evaluating quality of care for patients with heart failure. Circulation 2000; 101: E122–140 [DOI] [PubMed] [Google Scholar]
  • 23. Cowie MR, Wood DA, Coats AJ, Thompson SG, Poole‐Wilson PA, Suresh V, Sutton GC: Incidence and aetiology of heart failure: A population‐based study. Eur Heart J 1999; 20: 421–428 [DOI] [PubMed] [Google Scholar]
  • 24. Baker DW, Jones R, Hodges J, Massie BM, Konstam MA, Rose EA: Management of heart failure. III. The role of revascularization in the treatment of patients with moderate or severe left ventricular systolic dysfunction. J Am Med Assoc 1994; 272: 1528–1534 [DOI] [PubMed] [Google Scholar]
  • 25. Saxon LA, Stevenson WG, Middlekauff HR, Fonarow G, Woo M, Moser D, Stevenson LW: Predicting death from progressive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol 1993; 72: 62–65 [DOI] [PubMed] [Google Scholar]
  • 26. Philbin EF, DiSalvo TG: The influence of race and gender on process of care, resource utilization, and hospital‐based outcomes in congestive heart failure. Am J Cardiol 1998; 82: 76–81 [DOI] [PubMed] [Google Scholar]
  • 27. Philbin EF, Weil HFC, Erb TA, Jenkins PL: Cardiology or primary care for heart failure in the community setting: Process of care and clinical outcomes. Chest 1999; 116: 346–354 [DOI] [PubMed] [Google Scholar]
  • 28. Massie BM: 15 years of heart‐failure trials: What have we learned? Lancet 1998; 352 (suppl 1): SI29–33 [DOI] [PubMed] [Google Scholar]
  • 29. Philbin EF, Andreou C, Rocco TA, Lynch LJ, Baker SL: Patterns of angiotensin‐converting enzyme inhibitor use in congestive heart failure in two community hospitals. Am J Cardiol 1996; 77: 832–838 [DOI] [PubMed] [Google Scholar]
  • 30. Dries DL, Exner DV, Gersh BJ, Domanski MJ, Waclawiw MA, Stevenson LW: Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: A retrospective analysis of the SOLVD trials. Studies of Left Ventricular Dysfunction. J Am Coll Cardiol 1998; 32: 695–703 [DOI] [PubMed] [Google Scholar]
  • 31. Philbin EF, Jenkins PL: Differences between heart failure patients treated by cardiologists, internists, family physicians and other physicians: Analysis of a large, statewide database. Am Heart J 2000; 139: 491–496 [DOI] [PubMed] [Google Scholar]
  • 32. Goff DC Jr, Pandey DK, Chan FA, Ortiz C, Nichaman MZ: Congestive heart failure in the United States: Is there more than meets the I(CD code)? The Corpus Christi Heart Project. Arch Intern Med 2000; 160: 197–202 [DOI] [PubMed] [Google Scholar]
  • 33. Cheng V, Kazanagra R, Garcia A, Lenert L, Krishnaswamy P, Gardetto N, Clopton P, Maisel AS: A rapid bedside test for B‐type peptide predicts treatment outcomes in patients admitted for decompensated heart failure: A pilot study. J Am Coll Cardiol 2001; 37: 386–391 [DOI] [PubMed] [Google Scholar]
  • 34. Dao Q, Krishnaswamy P, Kazanegra R, Harrison A, Amirnovin R, Lenert L, Clopton P, Alberto J, Hlavin P, Maisel AS: Utility of B‐type natriuretic pep‐tide in the diagnosis of congestive heart failure in an urgent‐care setting. J Am Coll Cardiol 2001; 37 (2): 379–385 [DOI] [PubMed] [Google Scholar]
  • 35. McCullough PA, Soman SS, Shah SS, Smith ST, Marks KR, Yee J, Borzak SS: Risks associated with renal dysfunction in coronary care unit patients. J Am Coll Cardiol 2000; 36 (3): 679–684 [DOI] [PubMed] [Google Scholar]
  • 36. Grady KL, Dracup K, Kennedy G, Moser DK, Piano M, Stevenson LW, Young JB: Team management of patients with heart failure: A statement for healthcare professionals from The Cardiovascular Nursing Council of the American Heart Association. Circulation 2000; 102 (19): 2443–2456 [DOI] [PubMed] [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES