How Do We Compare?

What is heart failure?

Heart Failure - Quality Measures
MEASURE:	MEMORIALRESULTS Jul to Sep 2009 (Actual/Total)	COLORADO AVERAGE Apr 2008 to Mar 2009‡	NATIONALAVERAGE Apr 2008 to Mar 2009‡‡	TOP 10% NATIONAL MINIMUM SCORE Apr 2008 to Mar 2009†
Met all measures	81% (92/114)	No data available	No data available	No data available
Left ventricular function assessment	95% (108/114)	88%	90%	100%
ACEI or ARB on discharge	82% (36/44)	91%	89%	100%
Discharge instructions	91% (92/101)	73%	77%	99%
Smoking cessation	95% (18/19)	93%	92%	100%

KEY:

(‡) This is the most current data available for average Colorado hospital quality performance according to Centers for Medicare and Medicaid Services.
(‡‡) This is the most current data available for average national hospital quality performance according to Centers for Medicare and Medicaid Services.
(†) This is the most current data available for the minimum quality performance score of any national top 10% hospital according to the Joint Commission.

NOTE: Memorial results are highlighted in the blue column of data and annotated with one of the following quality indicators:

 = Achieved the best possible results
 = Above national average performance
 = At or near national average performance
 = Below national average performance

What is heart failure?

Heart failure, also called congestive heart failure, is a condition in which the heart cannot pump enough oxygenated blood to meet the needs of the body’s other organs. The heart keeps pumping, but not as efficiently as a healthy heart. Usually, the loss in the heart’s pumping action is a symptom of an underlying heart problem.

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What does “met all measures” mean?

This quality measure indicates the percentage of patients that successfully received all the heart failure quality measures they were qualified to receive.

This is a measure not typically reported or required by Joint Commission or CMS. Our hospital chooses to disclose this information voluntarily.

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What is a left ventricular function assessment and why is it important?

The left ventricle (LV) of the heart is the chamber that pumps blood to the rest of the body. Left ventricular function is often, but not always, impaired in persons with heart failure. The Joint Commission, in conjunction with the American College of Cardiology and American Heart Association, therefore, recommends LV assessment as a key diagnostic test for persons with suspected heart failure.

The most common test to assess LV function is the echocardiogram, or "echo." This test helps the physician determine how the heart is affected. There are three main parts of the heart that may be affected. The muscle (myocardium), valves, or covering (pericardium) may be affected, contributing to heart failure symptoms according to the American College of Cardiology (ACC) and American Heart Association (AHA) Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult.

The left ventricle is the part of the heart that holds and pumps blood to other vital organs. A measure called the left ventricular ejection fraction or LVEF is used to check for damage due to heart attacks and other conditions. The LVEF value for a person with no heart damage is usually around 60 percent or greater. Systolic dysfunction is a condition that causes reduced pumping ability of the heart's left lower ventricle and represents reduced pumping ability of the heart.

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What is an angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) and what do they do for the heart at discharge from the hospital?

According to the Agency for Healthcare Research and Quality (AHRQ): "Routine lifelong use of angiotensin converting enzyme (ACE) inhibitors [or angiotensin receptor blockers] is recommended for heart failure patients with depressed ejection fraction [the heart's bottom left chamber pumps 40 percent or less blood to the rest of the body], unless such use is contraindicated.

Yet a new study shows that nearly half of heart failure patients and one-third of those with depressed ejection fraction were not prescribed ACE inhibitors on Hospitals discharge. Almost one-third of patients who were discharged with ACE inhibitors had stopped taking them within a year. Considering that almost 50 percent of heart failure patients are readmitted to the Hospitals within 6 months of discharge, underuse of ACE inhibitors is a significant problem" (Journal of the American College of Cardiology, June 2, 2004: 43(11); 2036-2043).

Unless otherwise contraindicated, the protocol at Memorial Health System includes prescribing an angiotensin converting enzyme inhibitor or angiotensin receptor blocker medication for patients with heart failure at discharge from the hospital.

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Why is it important for patients to receive condition-specific discharge instructions?

According to the Heart Failure (HF) Society of America (HFSOA), heart failure is a chronic condition in which the heart's pumping ability is impaired, causing any combination of the following symptoms: fatigue, shortness of breath, and swelling in the ankles and legs. With proper medication and lifestyle changes, however, persons with heart failure may live longer and feel better.

Because HF is a complex condition, persons with heart failure and their family members will need to continue life-long learning about the condition and treatments used to keep HF patients stable and out of the hospital.

According to the Joint Commission, persons with heart failure benefit from hospital discharge instructions that include information on activity level, diet, discharge medications, follow-up appointments, weight monitoring, and what to do if symptoms worsen. Hospitals readmissions are common in persons with heart failure and educating patients and family members is crucial to successful heart failure management.

Scientific evidence supports condition-specific discharge planning and post-discharge support to optimize heart failure self-management and prevent readmission.

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Why should heart failure survivors receive smoking cessation advice?

Smoking is a modifiable risk factor for heart disease. National guidelines strongly recommend smoking counseling to help persons with heart disease quit smoking. (National Cancer Institute (NCI) Prevention and Cessation of Cigarette Smoking: Control of Tobacco Use). Tobacco Cessation Guidelines from the United States Department of Health and Human Services (DHHS) provide helpful tips on smoking cessation for patients.

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RELATED INFORMATION:

American Board of Medical Specialties
www.abms.org

American College of Cardiology (ACC)
www.acc.org

Agency for Healthcare Research and Quality (AHRQ)
www.ahrq.gov

American Heart Association (AHA)
www.american heart.org

Centers for Medicare and Medicaid Services (CMS)
www.cms.hhs.gov

Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample
http://hcup.ahrq.gov/HcupNet.asp

Heart Failure Society of America (HFSA)
www.hfsa.org

Joint Commission
www.jointcommission.org

National Cancer Institute
http://nci.nih.gov

National Center for Quality Assurance
www.ncqa.org

U.S. Department of Health and Human Services (DHHS)
www.surgeongeneral.gov

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