Magazine article American Nurse Today

Understanding Core Measures for Heart-Failure Treatment

Magazine article American Nurse Today

Understanding Core Measures for Heart-Failure Treatment

Article excerpt

Use The Joint Commission core measures to improve the care of patients with heart failure.

Heart failure (HF) occurs when the heart can't pump enough oxygenated blood to perfuse body organs. This condition is the primary cause of more than 55,000 deaths each year in the United States. The most common signs and symptoms of HF are shortness of breath on exertion; orthopnea; weight gain with edema in the feet, legs, or lower back; fatigue; and weakness. Major causes of HF are coronary artery disease, high blood pressure, and diabetes.

According to the Centers for Disease Control and Prevention (CDC), HF is diagnosed in 670,000 new persons annually. Currently, about 5.8 million persons in the United States are living with HF. In women, HF incidence has dropped by about 30% due to earlier diagnosis and treatment. In men, the number of new cases remains unchanged. The annual economic toll of HF is about $34.5 billion.

As with most diseases, the earlier HF is diagnosed and treated, the greater the chance for improving the patient's quality of life and increasing life expectancy. Over the past 50 years, scientists and healthcare providers have made great strides in treatment and patient outcomes by examining best practices for patients with HF.

Core measures

The Joint Commission introduced four initial core measurement areas for hospitals in May 2001; HF was one of these areas. The Joint Commission worked with the Centers for Medicare and Medicaid (CMS) on HF core measure sets. Standardized and renamed National Hospital Quality Measures, these core measure sets are expected to improve the quality of care for hospital patients while promoting examination of results of the care provided.

Currently, core measures for HF include:

* use of an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin II receptor blocker (ARB) for left ventricular systolic dysfunction (LVSD)

* left ventricular function (LVF) assessment

* smoking cessation counseling

* HF discharge instructions.

The Joint Commission uses these four items as hospital inpatient quality measures. In 2009, the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) proposed new focused guidelines, which include measurement of natriuretic peptides (BNP and NT-proBNP) when the diagnosis of HF is uncertain. The Joint Commission and CMS have yet to officially adopt this recommendation into the National Hospital Quality Measures.

Core measure: ACEI or ARB

ACEIs reduce the risk of HF-associated deaths by 15% to 25%. (An ARB may be substituted in patients with ACEI allergies). ACEIs include captopril (Capoten), lisinopril (Prinivil or Zestril), enalapril (Vasotec), and ramipril (Altace). ARBs include losartan (Cozaar), valsartan (Diovan), and irbesartan (Avapro). These drugs continue to decrease both mortality and the number of re-admissions among HF patients.

Core measures: LVF assessment

Evaluation of LVF guides treatment for HF patients and must be documented in the patient's medical record. Ideally, the best time to evaluate LVF is during the patient's initial evaluation. However, many patients with longstanding HF have never had LV assessment. Currently, proof of LV assessment must be documented on every hospital admission.

Two-dimensional echocardiography with Doppler is used to assess left ventricular ejection fraction (EF), left ventricular size, wall thickness, and valve function. EF indicates HF severity, guides treatment, and correlates mortality and morbidity risks. Normal EF values range from 50% to 70%.

Core measure: Smoking-cessation counseling

HF patients who have quit smoking report improved quality of life. Clinicians should recognize the value of smoking cessation for all patients, but especially for HF patients because it decreases their comorbidity risks. …

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