Quality of heart failure management: a comparison of care between a comprehensive heart failure program and a general cardiology practice

Abstract

This study evaluates adherence to guidelines by heart failure clinicians (HFCs) vs general cardiologists (GCs) for use of implantable cardioverter-defibrillators (ICDs), biventricular pacing devices (cardiac resynchronization therapy; CRT), and use of medications for heart failure (HF). The authors reviewed 563 patients with HF and an ejection fraction <or=35% for adherence to the 2005 American College of Cardiology/American Heart Association HF guidelines for the use of ICDs, CRT, and medications. There were 324 HFC and 239 GC patients. CRT guidelines were appropriately followed in 86% of HFC and 81% of GC patients ( P=NS). For primary arrhythmia prevention, an ICD was implanted in 107 (42%) HFC and 50 (25%) GC patients ( P<.004). Guidelines were appropriately followed in 77% of HFC and 74% of GC patients ( P=NS). For medications, dose intensity of diuretics, beta-blockers, and angiotensin-converting enzyme inhibitors was significantly greater in HFC than GC patients. Guideline-recommended beta-blockers were more frequently utilized by HFCs (97%) than GCs (82%). In conclusion, HFCs and GCs appropriately follow guidelines in the majority of cases, but HFCs use appropriate medications at higher dose intensity.