Adopted by the American Heart Association's Get With the Guidelines-Heart Failure quality improvement program and sponsored by drug maker GlaxoSmithKline, OPTIMIZE-HF is the largest effort of its kind undertaken for U.S. heart failure patients, with 259 hospitals participating. It is designed to help hospitals increase their adherence to standard hospital-based performance measures.

OPTIMIZE-HF also provides hospitals with tools to help improve the reliability of care, including standardized admission orders, discharge checklists, pocket cards, medical chart stickers, best-practice algorithms and critical pathways.

For the study, researchers looked at data from OPTIMIZE-HF's heart-failure performance-improvement registry, a Web-based program that allows hospitals to review and compare their data to data from similar facilities. Information in the registry included data on admission, discharge care and outcomes (e.g., death and re-hospitalization rates).

Between March 2003 and December 2004, 48,612 heart failure patients were enrolled in the registry. A subgroup of 5,791 patients were followed for an additional 60-90 days after they were discharged from the hospital.

The researchers found improvements in three of four of the Joint Commission on Accreditation of Healthcare Organization's performance measures used to gauge the quality of heart failure care in hospitals. They included:

• Better patient communication. The rate of giving complete medical instructions to patients increased from 46.8 percent at the beginning of the study to 66.5 percent by the study's end.
• Tougher anti-smoking efforts. Hospitals provided smoking cessation counseling to 75.6 percent of the patients at the end of the study, compared with 48.2 percent in the beginning.
• Improved heart monitoring. Evaluating the heart's left ventricle systolic function rose from 89.3 percent to 92.1 percent.

A fourth measure, involving prescribing an angiotensin-converting enzyme or angiotensin II receptor blocker medication at discharge, remained steady during the study.

The researchers found other improvements, as well. The use of beta-blockers rose from 78 percent to 86 percent, prescribing aldosterone antagonists increased from 11 percent to 20 percent, and the use of statin medications rose from 39 percent to 44 percent.

The rate of patient death while at the hospital dropped from 4.1 percent to 2.5 percent when hospitals used the standardized admission orders, and rates of death or hospitalization after hospital discharge decreased from 38.2 percent to 34.8 percent when the tools were used during care, the researchers found.

Another favorable outcome -- a decrease in deaths after hospital discharge from 9.9 percent to 6.3 percent -- could save thousands of lives if all hospitals participated in the initiative. In addition, the length of hospital stays dropped from 7.5 days to 6.2 days.

"If similar improvements had occurred at hospitals nationwide, this would translate to 40,000 less deaths and 1.4 million costly hospital days eliminated per year," principal investigator Dr. Gregg C. Fonarow, UCLA's Eliot Corday chair in cardiovascular medicine and science, director of the Ahmanson-UCLA Cardiomyopathy Center and professor of medicine at the David Geffen School of Medicine at UCLA, said in a prepared statement.

"Despite compelling scientific evidence and national guidelines for use of key life-prolonging agents and lifestyle changes, gaps exist in heart failure treatment," Fonarow said. "We hope more hospitals will adopt this validated model for enhancing heart-failure patient care."

More information

The American Heart Association has more about heart failure.