Abstract 19573: Factors Associated With Improvement in Ejection Fraction in Heart Failure Patients Following Implementation of a Practice-Based Performance Intervention: Findings From IMPROVE HF
Introduction: Available data suggest that improvement in ejection fraction (EF) is a major predictor of improved survival in heart failure (HF). While certain factors are associated with improvements in EF in select patients with HF enrolled in clinical trials, relatively little is known about such factors among patients in clinical practice. This study evaluated changes in EF and associated factors in outpatients with systolic HF or post-MI LVSD during 24 months of follow-up after a performance improvement intervention.
Methods: IMPROVE HF is a prospective evaluation of a practice-based performance improvement intervention implemented at outpatient cardiology practices to increase use of guideline-recommended care for eligible patients. Data were analyzed by patient groups based on absolute improvement in EF (<0%, 0-≤10%, and >10%) from baseline to 24 months and by change in EF (continuous variable).
Results: A total of 3994 patients from 155 of 167 practices were eligible for analysis. Overall mean EF increased from 25.8% at baseline to 32.3% (+6.4%) at 24 months (P<0.001), and 28.6% had a >10% EF increase. Age, race, and practice setting were similar between the 3 EF improvement groups, but a greater proportion of women were in the >10% EF group. Multivariate analysis revealed female sex, no prior MI, nonischemic HF etiology, and higher baseline LVEF, no ICD, no digoxin, as well as practice location, number of cardiologists, and device clinic, were associated with >10% improvement in EF post-intervention (Table). When analyzed as a continuous variable, university, teaching practice setting and shorter QRS duration were also associated with EF improvement, but practice region and device clinic were not.
Conclusions: Among HF patients receiving care in cardiology practices after implementation of a performance measure intervention, EF improved by 6.4% at 24 months. Diverse patient and practice factors were associated with significant improvements in EF.
- © 2010 by American Heart Association, Inc.