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CARDIOLOGY

Impact of Treatment Guidelines on Clinical and Economic Outcomes of Acute Decompensated Heart Failure

Clinical Associate Professor, Department of Pharmacy Practice and Affiliate Faculty, Center for Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, Chicago, IL

Alexandra Perez, PharmD

Research Fellow, Center for Pharmacoeconomic Research and Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago

Heather M Schumann, PharmD

Clinical Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago

Dee R Fontana, RN

Department of Medicine, Section of Cardiology, College of Medicine, University of Illinois at Chicago

George T Kondos, MD

Associate Professor, Department of Medicine, Section of Cardiology, College of Medicine, University of Illinois at Chicago

Glen T Schumock, PharmD MBA

Associate Professor, Department of Pharmacy Practice; Director, Center for Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago

Reprints: Dr. Schumock, Department of Pharmacy Practice, 833 S. Wood St. (M/C 886), Chicago, IL 60612, fax 312/996-0379, schumock{at}uic.edu

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 β-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 β-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.

Key Words: guidelines, heart failure, pharmacoeconomics

Published Online, February 26, 2008. www.theannals.com, DOI 10.1345/aph.1K496