Improving the use of evidence-based heart failure therapies in the outpatient setting: The IMPROVE HF performance improvement registry

Evidence-based consensus treatment guidelines are available to assist physicians with the management of chronic heart failure (HF). Although it has been generally presumed that physicians incorporate these treatment guidelines into clinical practice, the actual assimilation of evidence-based strategies and guidelines has been demonstrated to be less than ideal. Studies of HF care show that treatment guidelines are slowly adopted and inconsistently applied and, thus, often fail to lead to improvements in patient care and outcomes. There are a number of ongoing, large, national quality improvement registries that are following the clinical care and outcomes of inpatient HF treatment. However, to date, there have been no similar quality improvement registries in the outpatient arena. The Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) is the first large, comprehensive performance improvement registry designed to characterize the current outpatient management of systolic HF and assess the effect of practice-specific process improvement interventions consisting of education, specific clinical guidelines, reminder systems, benchmarked quality reports, and structured academic detailing on the use of evidence-based HF therapies. Seven performance measures to quantify the quality of outpatient HF care were explicitly developed by the IMPROVE HF Steering Committee. The primary objective is to observe, over the aggregate of IMPROVE HF practice sites, a relative 20% improvement in at least 2 of the 7 performance measures at 24 months, compared with baseline. Deidentified clinical data from the medical records of a planned 43 000 patients from 160 US cardiology practices will be included in this study.