Medication dosing in outpatients with heart failure after implementation of a practice-based performance improvement intervention: Findings from IMPROVE HF

Mihai Gheorghiade*, Nancy M. Albert, Anne B. Curtis, J. Thomas Heywood, Mark L. McBride, Patches Johnson Inge, Mandeep R. Mehra, Christopher M. O'Connor, Dwight Reynolds, Mary Norine Walsh, Clyde W. Yancy, Gregg C. Fonarow

*Corresponding author for this work

Research output: Contribution to journalArticle

52 Scopus citations

Abstract

Eligible outpatients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF) frequently do not receive target doses of HF medications. The Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) evaluated the effect of a practice-based performance improvement intervention on treatment of outpatients with LVEF ≤35%. Specific agent and dose were collected at baseline and 24months for angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs), β-blockers, and aldosterone antagonists. Changes in dosing over time were analyzed for each medication class. Data were available for 7605 patients. At baseline, target dose treatment rates were 36.1%, 20.5%, and 74.4%, respectively. Absolute and relative improvements of 9.8% and 47.7% (P<.001) were achieved for β-blocker dosing at 24months. The IMPROVE HF intervention was associated with significantly increased treatment of eligible patients with target doses of β-blockers but not ACE inhibitors/ARBs or aldosterone antagonists. Additional research to determine barriers to use of target doses of HF medications may be necessary.

Original languageEnglish (US)
Pages (from-to)9-17
Number of pages9
JournalCongestive Heart Failure
Volume18
Issue number1
DOIs
StatePublished - Jan 2012

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

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    Gheorghiade, M., Albert, N. M., Curtis, A. B., Thomas Heywood, J., McBride, M. L., Inge, P. J., Mehra, M. R., O'Connor, C. M., Reynolds, D., Walsh, M. N., Yancy, C. W., & Fonarow, G. C. (2012). Medication dosing in outpatients with heart failure after implementation of a practice-based performance improvement intervention: Findings from IMPROVE HF. Congestive Heart Failure, 18(1), 9-17. https://doi.org/10.1111/j.1751-7133.2011.00250.x