NHLBI Workshop

Data Needs for Cardiovascular Events, Management, and Outcomes

Studies Assessing Clinical Management Patterns and/or Patient Outcomes for Heart Failure -
Dr. Harlan Krumholz

Dr. Krumholz has studied extensively the management of heart failure.  He is a clinical coordinator for the National Heart Failure (NHF) Project, a quality improvement effort launched in 1999 by the then Health Care Financing Administration (HCFA) – now Centers for Medicare and Medicaid Services (CMS) – to improve care for Medicare beneficiaries hospitalized with heart failure.  A systematic national sample of fee-for-service Medicare patients hospitalized for heart failure in 1998-1999 was collected as part of this project.  As a national inpatient program, its baseline quality indicator rates were focused on rates of ejection fraction documentation and angiotensin-converting enzyme inhibitor prescription.  Data from the project have allowed him and his collaborators to assess various aspects of quality of care and patient outcomes concerning heart failure, including the treatment and outcome disparities that have been observed by gender and by race.

Dr. Krumholz pointed out that clinical management patterns of heart failure vary.  For example, he speculated that it is likely that the criteria clinicians use to determine whether to treat a patient with acute exacerbation of heart failure as outpatient versus inpatient often differ among physicians and by location.  Quality indicators of heart failure management are mostly limited to ejection fraction documentation and angiotensin converting-enzyme prescriptions – for which rates are too low for both measures nationally.  There do not appear to be many national quality improvement projects on the horizon that involve the collection of data that can be used for surveillance.  There is a particular lack of data on outpatient management as well as outpatient self-monitoring of this disease.  There is a great need to assess disparities. He expressed concern that as new and more invasive treatment technologies such as implantable cardiac defibrillators become available, the high costs of such treatment may inadvertently widen the gap of current disparities.  To track the impact of marked anticipated changes in the care of patients with heart failure and the changing risk patterns of the population, there exists a great need for reliable surveillance efforts that focus on incidence, treatment, disparities, and outcome

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