Special Report: CHF

Keeping up to speed on what's happening in the field of congestive heart failure (CHF) is essential to your job, and Cost Management in Cardiac Care is here to help. A sampling of the literature shows a lot of activity. Guidelines are being questioned, cost-effectiveness studies are being conducted, and better diagnostics and therapies are in the pipeline.

Here's an example: Because CHF shortens life expectancy, current guidelines suggest that patients with a low likelihood of survival be excluded from intensive care. But how well do physicians predict probability for survival? A study from Memorial Hospital in Pawtucket, RI, concluded that current triage protocols may be, at best, impractical or even harmful.1

Another study shows that up to one-fourth of Medicare CHF patients who could benefit from angiotensin-converting enzyme (ACE) inhibitors are not receiving them.2 Use of the drug appears to decrease with advancing age even though experts like Randolph R. Peto at the Massachusetts Peer Review Organization in Waltham says ACE inhibitors "may be even more cost-effective for 80-year-olds than for 60-year-olds." Only 73% of a random sample of elderly patients admitted to hospitals for heart failure were considered candidates; only 67% of those over 85 received the therapy. And those are patients with no clear contraindications.

This issue of CMC contains a selection of articles on what facilities around the country are doing to improve care and save money. In next month's issue, we will feature even more success stories to help you effectively cope with the challenges of managing CHF patients.


1. Poses RM, Smith WR, McClish DK, et al. Physicians' survival predictions for patients with acute congestive heart failure. Arch Intern Med 1997; 157:1,001-1,007.

2. The Large State Peer Review Organization Consortium. Heart failure treatment with angiotensin-converting enzyme inhibitors in hospitalized medicare patients in 10 large states. Arch Intern Med 1997; 157:1,103-1,108.