In:
Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 5, No. suppl_1 ( 2012-04)
Abstract:
Background: Beta-blockers (BB) and angiotensin converting enzyme inhibitors (ACE)/angiotensin receptor blockers (ARB) are guideline recommended therapies for ambulatory heart failure patients with reduced left ventricular ejection fraction (HFREF). Real-world use of these therapies is suboptimal. Whether variations in treatment are dominated by practice-level or patient-level factors is unknown. Methods: Practices participating in the NCDR PINNACLE program, a national office-based cardiac quality improvement registry, between July 2008 and December 2010 were evaluated. Rates of treatment with BB and ACE/ARB were evaluated in patients with HFREF (EF ≤40%) and no documented contraindication. Multivariable hierarchical relative risk regression models, including demographics, insurance status, comorbidities and a random effect for practice were used to determine 1) patient-level and 2) practice-level variation in treatment rates. To quantify practice-level variation, the median rate ratio (MRR) was calculated, which estimates the typical rate ratio between two randomly selected practices for patients with identical covariates. In general, MRRs ≥ 1.2 indicate significant variation by practice. The MRR is always 〉 1.0 but can be compared in magnitude to patient-level risks. Results: We studied 12384 patients in 45 practices. The mean practice rate for BB treatment was 87% (IQR 83%-95%; range: 43%-100%), and the mean practice rate of ACE/ARB treatment was 90% (IQR 75%-88%; range: 18%-100%). The MRR was 1.09 for BB and 1.16 for ACE/ARB therapy. For both BB and ACE/ARB, the adjusted MRR for site level variation was larger than the rate ratio for other patient factors. (Table) Conclusions: Although rates of BB and ACE/ARB treatment among outpatients with HFREF are high, clinically meaningful variation by practice is present and explains a larger amount of the observed variance than any patient characteristic. This suggests that addressing practice-level factors represents an important opportunity to improve the use of evidence-based HF therapy.
Type of Medium:
Online Resource
ISSN:
1941-7713
,
1941-7705
DOI:
10.1161/circoutcomes.5.suppl_1.A75
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2012
detail.hit.zdb_id:
2453882-6
