This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Weil, E.
Right arrow Articles by Tu, J. V.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Weil, E.
Right arrow Articles by Tu, J. V.
Related Collections
Right arrow Heart failure
Right arrow Guidelines
Right arrow Changing physician behaviour
Right arrow Quality improvement
CMAJ • August 7, 2001; 165 (3)
© 2001 Canadian Medical Association or its licensors

Research
Recherche

Quality of congestive heart failure treatment at a Canadian teaching hospital

Evette Weil and Jack V. Tu

Ms. Weil is a third-year student in the Faculty of Medicine, University of Toronto, Toronto, Ont. Dr. Tu is with the Institute for Clinical Evaluative Sciences, the Division of General Internal Medicine, Sunnybrook & Women's College Health Sciences Centre, and the Department of Medicine, Public Health Sciences, Health Administration, University of Toronto, Toronto, Ont.

Correspondence to: Dr. Jack V. Tu, Institute for Clinical Evaluative Sciences, Rm. G-106, 2075 Bayview Ave., Toronto ON M4N 3M5; fax 416 480-6048; tu{at}ices.on.ca

Background: Practice guidelines for the management of congestive heart failure (CHF) emphasize the need for assessment of left ventricular function and treatment with angiotensin-converting enzyme (ACE) inhibitors. However, previous studies have shown that many patients do not receive these tests or medications. The objective of this study was to evaluate the compliance of physicians at a large Canadian teaching hospital with published CHF management guidelines.

Methods: We conducted a retrospective review of the charts of 200 patients admitted to Sunnybrook & Women's College Health Sciences Centre, Toronto, in 1997 for whom CHF was the diagnosis most responsible for the hospital admission. Quality of care was measured with 3 indicators: the use of left ventricular function testing to determine systolic versus diastolic dysfunction; the prescription of ACE inhibitors to appropriate patients (those with systolic dysfunction, no contraindications to ACE inhibitor therapy and no angiotensin II receptor blocker use); and the prescription of target doses of ACE inhibitors.

Results: Of the 200 patients 177 (88.5%) received left ventricular function testing before or during their hospital stay; of the 177, 117 (66.1%) had systolic dysfunction. A total of 100 patients were considered to be ideal candidates for ACE inhibitor treatment. Of the 100, 89 (89.0%) received ACE inhibitors; however, only 23 (23.0%) were prescribed target doses.

Interpretation: Most patients who had CHF at this Canadian hospital received left ventricular function testing and ACE inhibitor therapy. Future educational efforts should focus on the importance of adequate dosing of ACE inhibitors.




This article has been cited by other articles:


Home page
 QJMHome page
P. Roman-Sanchez, P. Conthe, J. Garcia-Alegria, J. Forteza-Rey, M. Montero, C. Montoto, and for the Heart Failure Working Group of the Spanish
Factors influencing medical treatment of heart failure patients in Spanish internal medicine departments: a national survey
QJM, February 1, 2005; 98(2): 127 - 138.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
D. Johnson, Y. Jin, H. Quan, and B. Cujec
Beta-blockers and angiotensin-converting enzyme inhibitors/receptor blockers prescriptions after hospital discharge for heart failure are associated with decreased mortality in Alberta, Canada
J. Am. Coll. Cardiol., October 15, 2003; 42(8): 1438 - 1445.
[Abstract] [Full Text] [PDF]

Home page
 CMAJHome page
N. Giannetti
Management of congestive heart failure: How well are we doing?
Can. Med. Assoc. J., August 1, 2001; 165(3): 305 - 306.
[Full Text] [PDF]