Effect of a Hospital and Postdischarge Quality Improvement Intervention on Clinical Outcomes and Quality of Care for Patients With Heart Failure With Reduced Ejection Fraction: The CONNECT-HF Randomized Clinical Trial<\/h1>\n\n\n\n
Adam D.\u00a0DeVore,\u00a0Bradi B.\u00a0Granger,\u00a0Gregg C.\u00a0Fonarow,\u00a0et al<\/h3>\n\n\n\n
Importance<\/strong>\u00a0\u00a0Adoption of guideline-directed medical therapy for patients with heart failure is variable. Interventions to improve guideline-directed medical therapy have failed to consistently achieve target metrics, and limited data exist to inform efforts to improve heart failure quality of care.<\/p>\n\n\n\n
Objective<\/strong> To evaluate the effect of a hospital and postdischarge quality improvement intervention compared with usual care on heart failure outcomes and care.<\/p>\n\n\n\n
Design, Setting, and Participants<\/strong> This cluster randomized clinical trial was conducted at 161 US hospitals and included 5647 patients (2675 intervention vs 2972 usual care) followed up after a hospital discharge for acute heart failure with reduced ejection fraction (HFrEF). The trial was performed from 2017 to 2020, and the date of final follow-up was August 31, 2020.<\/p>\n\n\n\n
Interventions<\/strong> Hospitals (n\u2009=\u200982) randomized to a hospital and postdischarge quality improvement intervention received regular education of clinicians by a trained group of heart failure and quality improvement experts and audit and feedback on heart failure process measures (eg, use of guideline-directed medical therapy for HFrEF) and outcomes. Hospitals (n\u2009=\u200979) randomized to usual care received access to a generalized heart failure education website.<\/p>\n\n\n\n
Main Outcomes and Measures<\/strong> The coprimary outcomes were a composite of first heart failure rehospitalization or all-cause mortality and change in an opportunity-based composite score for heart failure quality (percentage of recommendations followed).<\/p>\n\n\n\n
Results<\/strong> Among 5647 patients (mean age, 63 years; 33% women; 38% Black; 87% chronic heart failure; 49% recent heart failure hospitalization), vital status was known for 5636 (99.8%). Heart failure rehospitalization or all-cause mortality occurred in 38.6% in the intervention group vs 39.2% in usual care (adjusted hazard ratio, 0.92 [95% CI, 0.81 to 1.05). The baseline quality-of-care score was 42.1% vs 45.5%, respectively, and the change from baseline to follow-up was 2.3% vs \u22121.0% (difference, 3.3% [95% CI, \u22120.8% to 7.3%]), with no significant difference between the 2 groups in the odds of achieving a higher composite quality score at last follow-up (adjusted odds ratio, 1.06 [95% CI, 0.93 to 1.21]).<\/p>\n\n\n\n<\/figure>\n\n\n\n
Conclusions and Relevance<\/strong> Among patients with HFrEF in hospitals randomized to a hospital and postdischarge quality improvement intervention vs usual care, there was no significant difference in time to first heart failure rehospitalization or death, or in change in a composite heart failure quality-of-care score.<\/p>\n\n\n\n
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