Abstract 3993: Quality of Care for Heart Failure Patients with Concomitant Kidney Disease in the American Heart Association’s Get With The Guidelines Heart Failure (GWTG-HF) Program
Background: Kidney disease is recognized as a major risk factor for major morbidity and mortality in HF patients. Quality of care for such patients is unknown. GWTG-HF is a quality improvement initiative of the AHA and a unique resource to characterize the quality of care for patients hospitalized for HF with concomitant renal disease.
Methods: GWTG-HF uses a collaborative model of care and a web-based pt management tool for data collection, decision support, on-demand reporting, and pt education. Data were collected by 146 hospitals for 5 pre-specified performance measures (PM): discharge instructions, LV function measurement, ACEI/ARB use, beta blocker (BB) use, smoking cessation counseling and a composite measure of % patients who receive all of the 5 measures for which they were eligible. Control of hypertension on discharge was also examined. After adjusting for patient characteristics, use of PM was analyzed based on severity of kidney disease as estimated by MDRD glomerular filtration rate (eGFR) in 5 categories: Normal >90; Mild 60–90; Moderate 30 – 60; Severe 15–30; Kidney Failure <15 ml/min/1.73m2.
Results: The distribution of patients based on eGFR was: Normal 8.5%; Mild 26.8%; Moderate 43.9%; Severe 14.2% and Kidney Failure 6.6%. Adjusted data demonstrate that PMs frequently varied across the spectrum of kidney disease and the composite measure was much lower in patients with more severe kidney disease. Control of hypertension was also often unmet.
Conclusions: Treatment of HF patients in GWTG-HF varies greatly with severity of kidney disease. Recognition of kidney disease and improving quality of care is needed for these high risk patients.