Counting Performance With Therapies for Heart Failure

Patients with heart failure and reduced ejection fraction account for about half of the 6 million patients with heart failure and the $35 billion spent annually on related medical costs. Over the past 25 years, heart failure management has evolved through randomized trials of specific therapy and the extensive clinical experience accumulated at referral centers, many of which arose initially to offer comprehensive medical care for patients in parallel with cardiac transplantation, as described by Fonarow et al in 1997.1 The recommended therapies have been the subject of extensive guidelines, from the first Agency for Health Care Policy and Research guidelines chaired by Konstam in 19942 to the most recent American College of Cardiology (ACC)/American Heart Association (AHA) guidelines chaired by Hunt in 20053 and updated by Jessup et al in 2009.4 Lessons from implementation of measures for acute myocardial infarction have translated into heart failure management, as described by O'Connor.5 Outcomes with heart failure have improved remarkably as these therapies have become widely implemented, and even disparities by race have begun to diminish, as underlined by Yancy et al6; however, the remaining burdens of readmission and mortality warrant ongoing efforts to further improve care for the diverse populations with heart failure.Article see p 585 The interventions of the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) described in this issue of Circulation 7 successfully increased the number of therapies provided to patients with heart failure. Testing the impact of a strategy on practice is challenging, because the investigators cannot be blinded and are exposed to center effects, which may have played a role here. Simultaneous trends in continuing education and community practice also influence practice patterns over time. Data were collected by 34 …