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Heart Failure Care Performance Detail
What this information tells us
These data illustrate the “composite” measure of how consistently hospitals provided evidence-based care for heart failure in 2006. The number of hospitals (left axis) is shown in relation to the composite measure rate (bottom axis) for the four evidence-based heart failure treatments or measures evaluated in this report. Data represented by this illustration were reported by 3,074 total hospitals.
Results
During 2006, the national average for providing the four evidence-based heart failure treatments or measures evaluated in this report was 84.1 percent, an improvement of 24.4 percentage points from 2002, when The Joint Commission began tracking performance on heart attack measures. The bars on the chart show the approximate number of hospitals achieving varying composite measure rates, which are plotted on a scale of 0 to 100 percent in 2.5 percent intervals. For example, the highest bars show that most hospitals achieved composite measure rates between roughly 75 to 95 percent in 2006.
What one should know about the data
Hospitals were required to have a minimum of 30 patients in order to report these data. That was the minimum sample size required for a hospital to receive a rating on Quality Check.
What this information tells us
These data report the percentage of heart failure patients who are given specific discharge instructions about their condition and care when they leave the hospital.
What’s important to know about heart failure after being hospitalized
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One study showed that during the past 20 years, heart failure has not declined, but survival after being diagnosed has increased. 11, 37
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Patient education about activities, diet, follow-up, medicines, worsening symptoms, and monitoring weight can prevent further hospitalization. National guidelines strongly support patient education. 14, 37
Results
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In 2006, Joint Commission-accredited hospitals achieved national average performance of 70.3 percent in providing discharge instructions to heart failure patients – an improvement of 11.1 percentage points from 2005, of 20.7 percentage points from 2004, of 27.9 percentage points from 2003, and of 39.4 percentage points from 2002.
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Performance rates among states ranged from 49.4 to 91.0 percent.
What one should know about the data
What this information tells us
These data report the percentage of heart failure patients who received an in-depth evaluation of the function of the main pumping chamber of the heart (the left ventricle) during their hospitalization, or during pre-admission to, or after discharge from, the hospital.
What’s important to know about heart failure and left ventricular function assessment
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The left ventricle is the thickest muscle of the heart and carries the major workload of the heart. 15, 37
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Left ventricular heart failure is one of the most common form of heart failure in the United States. It is a condition in which the muscles of the left side of the heart (left ventricle) become weakened and have to work harder to pump blood. This type of heart failure often causes breathing difficulties. 16, 37
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The tests that can help determine left ventricular function include echocardiograms, radionuclide angiography and cardiac catheterizations. If the test shows that the left ventricle is not pumping blood effectively, the condition is known as left ventricle systolic dysfunction (LVSD). 16, 37
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National guidelines promote left ventricular function assessment as the single most important test for heart failure patients. 16, 37
Results
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In 2006, Joint Commission-accredited hospitals achieved national average performance of 93.4 percent in providing a left ventricular function assessment to heart failure patients - an improvement of 2.5* percentage points from 2005, of 5.9 percentage points from 2004, of 8.9 percentage points from 2003, and of 11.9 percentage points from 2002.
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Performance rates among states ranged from 77.8 to 97.0 percent.
What one should know about the data
Some heart failure patients had their left ventricular function assessed but were excluded from these data for one or more of the following reasons:
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The patient had a left ventricular assist device (LVAD) or heart transplant.
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The patient was younger than 18 years of age.
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The patient was transferred to another acute care or federal hospital.
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The patient was discharged to hospice.
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The patient left against medical advice.
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The patient received comfort care only.
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The patient died.
* This number varies from that in the previous report due to later additional data submissions and/or corrections to previously submitted data.
What this information tells us
These data report the percentage of heart failure patients who were given advice or counseling about quitting smoking.
What's important to know about heart failure and smoking
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More than 25 percent of adult American men and 20 percent of adult American women are smokers. 6, 37
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Studies show that smokers are more likely to quit smoking if a doctor advises them to stop. 7, 37
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One year after quitting smoking, a person's risk of heart disease decreases by 50 percent. 6, 37
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National guidelines strongly recommend smoking cessation counseling for heart failure patients who smoke. 8, 37
Results
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In 2006, Joint Commission-accredited hospitals achieved national average performance of 92.1 percent in advising heart failure patients to quit smoking - an improvement of 8.2* percentage points from 2005, of 22.5* percentage points from 2004, of 35.3 percentage points from 2003, and of 49.9 percentage points from 2002.
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Performance rates among states ranged from 74.4 to 97.8 percent.
What one should know about the data
Some heart failure patients received smoking cessation advice but were excluded from these data for one or more of the following reasons:
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The patient had a left ventricular assist device (LVAD) or heart transplant.
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The patient was younger than 18 years of age.
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The patient was transferred to another acute care or federal hospital.
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The patient was discharged to hospice.
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The patient left against medical advice.
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The patient received comfort care only.
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The patient died.
* This number varies from that in the previous report due to later additional data submissions and/or corrections to previously submitted data.
What this information tells us
These data report the percentage of heart failure patients who received a prescription for medicine called an ACE inhibitor or an ARB when they were discharged from the hospital. ACE stands for angiotensin converting enzyme. ARB stands for angiotensin receptor blocker. ACE inhibitors, also called ACEIs, and ARBs are medicines taken by mouth that reduce blood pressure and strengthen the heart beat.
What's important to know about ACE inhibitors, ARBs, and heart failure
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ACE inhibitor and ARB medicines improve the heart's ability to pump blood to the body. 17, 37
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Heart failure patients who take ACE inhibitor and ARB medicine have fewer symptoms, are physically better, and reduce their risk of returning to the hospital. 18, 19, 37
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National guidelines strongly recommend ACE inhibitor and ARB medicine for heart failure patients. 14, 37
Results
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In 2006, Joint Commission-accredited hospitals achieved national average performance of 85.6 percent in prescribing ACE inhibitor and/or ARB medication of heart failure patients when they were discharged from the hospital - an improvement of 2.6 percentage points from 2005, of 9.3 percentage points from 2004, of 9.8 percentage points from 2003, and of 11.4 percentage points from 2002.
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Performance rates among states ranged from 80.5 to 92.3 percent.
What this information tells us
Some heart failure patients received this treatment but were excluded from these data for one or more of the following reasons:
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The patient did not receive an ACE inhibitor and/or ARB due to an allergy to the medicine or other medical reasons.
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The patient had a left ventricular assist device (LVAD) or heart transplant.
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The patient was younger than 18 years of age.
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The patient was transferred to another acute care or federal hospital.
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The patient was discharged to hospice.
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The patient left against medical advice.
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The patient received comfort care only.
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The patient died.
Key to abbreviations: ACEI: Angiotensin converting enzyme inhibitor, ARB: angiotensin receptor blocker, LVF: Left ventricular function. See Glossary for definitions.
What this information tells us
These graphs show the national performance rates of Joint Commission-accredited hospitals over the course of four consecutive years (2002-2006) for the four heart failure measures evaluated in this report.
What's important to know about heart failure
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About one in every 100 people over the age of 65 has chronic heart failure. 11, 37
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Heart failure affects 2 to 3 million Americans. 12, 37
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From 1999 to 2002, almost 5 million Americans were diagnosed with heart failure. 11, 37
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One study showed that during the past 20 years, heart failure has not declined, but survival after being diagnosed has increased. 11, 37
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From 1999 to 2002, almost 5 million Americans were diagnosed with heart failure, and deaths from heart failure increased 35.3 percent. 11, 37
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In 2005, the estimated cost of heart failure in the United States was $27.9 billion. 11, 37
Results
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In 2006, Joint Commission-accredited hospitals reported steady improvement over the course of the study in all of the heart failure measures, with the most significant improvement in providing both discharge instructions and smoking cessation advice to heart failure patients.
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The best rates of performance were for:
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Providing left ventricular function (LVF) assessment improved from 81.5 percent in 2002, to 84.5 percent in 2003, to 87.5 percent in 2004, to 90.9* percent in 2005, to 93.4 percent in 2006.
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Providing smoking cessation advice improved from 42.2 percent in 2002, to 56.8 percent in 2003, to 69.6* percent in 2004, to 83.9* percent in 2005, to 92.1 percent in 2006.
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Providing ACE inhibitor or ARB at discharge improved from 74.2 percent in 2002, to 75.8 percent in 2003, to 76.3 percent in 2004, to 83.0 percent in 2005, to 85.6 percent in 2006.
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Providing discharge instructions improved significantly since 2005, up 11.1 percent to 70.3 percent.
What one should know about the data
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These data measure specific "processes" of care for heart failure. In this instance, the study counts the number patients receiving the recommended care for heart failure.
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While improvement sometimes is less than 1 percentage point, these are statistically significant improvements because of the larger number of hospitals that reported these data during the time period covered in this graph.
* This number varies from that in the previous report due to later additional data submissions and/or corrections to previously submitted data.
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Page 3
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