CHF study finds gaps in diagnosis, treatment
CHF study finds gaps in diagnosis, treatment
Discharge instructions fall short as well
A study of congestive heart failure (CHF) patients recently completed by the Missouri Patient Care Review Foundation (MPCRF) in Jefferson City, MO, indicates physicians don’t always provide the best diagnoses and treat the disease.
The foundation’s Regional CHF Cooperative Project examined whether patients were receiving left ventricular function assessments and if they were put on ACE inhibitors to improve left ventricular diastolic disfunction, according to Carl Bynum, DO, MPH, principal clinical coordinator for MPCRF, which contracts with the federal Health Care Financing Administration (HCFA) to monitor quality of care for Medicare beneficiaries. The study revealed that the assessment is "not routinely done," Bynum says. "[A lot] of times, physicians are evaluating and making a diagnosis based on symptoms. To accurately diagnose [left ventricular diastolic disfunction], you have to evaluate the function of the heart. It’s important, because it determines what medication the patient should be placed on."
The assessment of cardiac function was performed in 72% of the patients studied, Bynum says, and most of the suitable patients to be put on ACE inhibitors were given the treatment. This means the study did not consider patients who were allergic to ACE inhibitors or had some other reason for not taking the medication.
"Of ideal patients, 80% were put on ACE inhibitors," Bynum notes. "That’s not too bad, but there are still another 20% that had the potential of being on the medication."
The foundation is working with hospitals involved in the study to implement plans to educate their physicians and change their processes, he says. "This is an important aspect of the overall treatment of these patients, and we need to make sure there are processes in place to evaluate that."
Another aspect of the study looked at discharge planning for the patients, Bynum says. It found that 46% received instructions on medication, 27% received instructions on diet, and only 10% were instructed on weight monitoring. "We looked at what was written in the chart; and for our purposes, if it wasn’t written in the chart, it didn’t happen."
Post-discharge monitoring is a very important part of preventing complications from CHF, Bynum points out. "For patients to recognize that they might be retaining fluid, need[ing] to call the physician, or make some changes" is crucial, he says.
Hospitals that fell short in this area might want to develop a preprinted form or take some other action to alert nurses and physicians to the importance of discharge planning, he suggests.
MPCRF continues to analyze data from the study, which was initiated by the HCFA’s Kansas City regional office, with final outcomes due in December. The study involved eight states, but the percentages cited applied only to the Missouri patients.
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