The aim of this article was to measure guideline compliance in the care of health plan members diagnosed with congestive heart failure (CHF). Chart review was conducted on members with a discharge diagnosis of CHF (n = 2697). Information was entered onto a scannable form designed by the health plan, which was coupled to an optical character recognition reader and entered into a database. Eighty-four percent of the patients had an ejection fraction (EF) measured. An angiotensin-converting enzyme inhibitor was prescribed to 72% of patients with an EF less than 40%. Comorbidities and other measures were evaluated and based on guideline recommendations. Most of the CHF patients in this health plan are being treated appropriately during posthospitalization for CHF. The use of a novel, cost-effective method for data collection resulted in the rapid acquisition of clinical data for analysis.
American Heart Association. 2002 Heart and Stroke Statistical Update. Dallas, Tex: American Heart Association;2001.
2.
Medicare+ Choice. QAPI heart failure indicators: optional quality indicator specification for use with optional Medicare + Choice organization heart failure data collection tool. Available at: www.hcfa.gov/medicare/qapi-0601.rtf. Accessed June 1, 2001.
3.
Hunt SA, Baker DW, Chin MH, et al.ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult: A Report of the American College of Cardiology /American Heart Association Task Force on Practice Guidelines [Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure]. Bethesda, Md: American College of Cardiology Educational Services. 2001. Available at: http:Hwww.acc.org/clinical/guidelines/failure/hf%/5Findex.htm.
4.
Diller PM, Smucker DR, David B, et al.Congestive heart failure due to diastolic or systolic dysfunction. Arch Fam Med. 1999;8: 414-420.
5.
Kizer JR, Kimmel SE. Epidemiologic review of the calcium channel blocker drugs: an up to date perspective on the proposed hazards. Arch Intern Med. 2001;161:1145-1158.
6.
Sica D. The heart outcomes prevention evaluation (HOPE) study: limitations and strengths. J Clin Hypertens. 2000;2(6): 406-409.
7.
Jamali AH, Wilson Tang WH, Khot UN, et al.The role of angiotensin receptor blockers in the management of chronic heart failure. Arch Intern Med. 2001;161:667-671.
8.
Van Kraaij D, Jansen R, Gribnau F, et al.Diuretic therapy in elderly heart failure patients with and without left ventricular dysfunction. Drugs Aging. 2000;16(4):289-300.
9.
Francis G, Siegel R, Goldsmith S, et. al.Acute vasoconstrictor response to intravenous furosemide in patients with chronic congestive heart failure. Ann Intern Med. 1985;103:1-6.
10.
Ramachandran SV, Beiser A, Seshadri S, et al.Residual lifetime risk for developing hypertension in middle-aged women and men: the Framingham heart study. JAMA. 2002;287:1003-1010.
11.
Levy D, Larson MG, Vasan RS, et al.The progression from hypertension to congestive heart failure. JAMA. 1996;275:1557-1562.
12.
Ramachandran S, Levy D. The role of hypertension in the pathogenesis of heart failure: a clinical mechanistic overview. Arch Intern Med. 1996;156:1789-1796.
13.
Singh B. Heart Failure and Atrial Fibrillation: Impact of New Research Findings on Treatment. Online Coverage of the 50th Annual Scientific Session of the American College of Cardiology: Heart Failure.
14.
Gould K, Ornish D, Scherwitz L, et al.Changes in myocardial perfusion abnormalities by positron emission tomography after long-term, intense risk factor modification. JAMA. 1999;274(11): 894-900.
15.
Haffner S, Lehto S, Ronnemaa T, et al.Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998;339:229-234.
16.
Reuters Health Information 2002. NSAID use linked to relapse but not first occurrence of heart failure. Arch Intern Med. 2002; 162:265-270.
17.
Javaheri S, Corbett W. Association of low PaCO2 with central sleep apnea and ventricular arrhythmias in ambulatory patients with stable heart failure. Ann Intern Med. 1998;128(3):204-207.
18.
Hall D. Controversies in heart failure: are beneficial effects of angiotensin-converting enzyme inhibitors attenuated by aspirin in patients with heart failure?Cardiol Clin. 2001;19(4):597-603.
19.
Guazzi M, Pontone G, Agostoni P. Aspirin worsens exercise performance and pulmonary gas exchange in patients with heart failure who are taking angiotensin-converting enzyme inhibitors. Am Heart J1999;138(2):254-260.
20.
Stys T. Lawson WE, Smaldone GC, et al.Does aspirin attenuate the beneficial effects of angiotensin-converting enzyme inhibition in heart failure?Arch Intern Med. 2000;160:1409-1413.
21.
Foody J, Farrell M, Krumholz, H. Beta-blocker therapy in heart failure, scientific review. JAMA. 2002;287(7):883-889.
