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Heart. 2019 Mar;105(6):431-438. doi: 10.1136/heartjnl-2018-314129. Epub 2019 Jan 30.

Hospital-based quality improvement interventions for patients with heart failure: a systematic review.

Author information

1
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
2
Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.
3
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
4
Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
5
Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum Medical College, Trivandrum, Kerala, India.
6
Department of Medicine, Duke University Hospital, Durham, North Carolina, USA.
7
Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
8
Centre for Chronic Disease Control, New Delhi, India.
9
Public Health Foundation of India, Gurugram, Haryana, India.
10
The George Institute for Global Health, Sydney, New South Wales, Australia.

Abstract

OBJECTIVE:

To estimate the direction and magnitude of effect and quality of evidence for hospital-based heart failure (HF) quality improvement interventions on process of care measures and clinical outcomes among patients with acute HF.

REVIEW METHODS:

We performed a structured search to identify relevant randomised trials evaluating the effect of in-hospital quality improvement interventions for patients hospitalised with HF through February 2017. Studies were independently reviewed in duplicate for key characteristics, outcomes were summarised and a qualitative synthesis was performed due to substantial heterogeneity.

RESULTS:

From 3615 records, 14 randomised controlled trials were identified for inclusion with multifaceted interventions. There was a trend towards higher in-hospital use of ACE inhibitors (ACE-I; 57.9%vs40.0%) and beta-blockers (BBs; 46.7%vs10.2%) in the intervention than the comparator in one trial (n=429 participants). Five trials (n=78 727 participants) demonstrated no effect of the intervention on use of ACE-I or angiotensin receptor blocker at discharge. Three trials (n=89 660 participants) reported no effect on use of BB at discharge. Two trials (n=419 participants) demonstrated a trend towards lower hospital readmission up to 90 days after discharge. There was no consistent effect of the quality improvement intervention on 30-day all-cause mortality, hospital length of stay and patient-level health-related quality of life.

CONCLUSIONS:

Randomised trials of hospital-based HF quality improvement interventions do not show a consistent effect on most process of care measures and clinical outcomes. The overall quality of evidence for the prespecified primary and key secondary outcomes was very low to moderate, suggesting that future research will likely influence these estimates.

TRIAL REGISTRATION NUMBER:

CRD42016049545.

KEYWORDS:

heart failure; quality and outcomes of care; systemic review

PMID:
30700515
DOI:
10.1136/heartjnl-2018-314129
[Indexed for MEDLINE]

Conflict of interest statement

Competing interests: MDH receives funding from the World Heart Federation to serve as its senior programme advisor for the Emerging Leaders programme, which is supported by Boehringer Ingelheim and Novartis with previous support from BUPA and AstraZeneca. MDH also receives support from the American Heart Association, Verily and AstraZeneca for work unrelated to this research.

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