A hospital and post-discharge quality improvement (QI) intervention that focused on clinician education and audit and feedback of heart failure (HF) quality of care did not meaningfully improve patient outcomes or care beyond existing QI efforts, according to findings from the CONNECT-HF trial presented May 17 during ACC.21.

Over the course of three years, the study enrolled 5,647 patients treated for HF with reduced ejection fraction at 161 participating hospitals. All hospitals already had an on-site QI program designed to ensure compliance with guideline-based practices for HF treatment and reduce negative outcomes such as rehospitalization and death.

For those hospitals randomized to receive the additional QI intervention, researchers worked with each hospital's in-house QI team to review and improve existing programs to reinforce evidence-based practices. For example, if a hospital found that many patients with HF were not taking prescribed medicines reliably, the QI team might work with in-house pharmacists to ensure patients start taking their medications before being discharged. The researchers independently tracked hospital discharges and post-discharge follow-up care and provided feedback to hospital care teams on performance metrics, a strategy of audits and feedback that had worked for other QI initiatives in previous studies.

Results found the first co-primary endpoint of HF rehospitalization or death from any cause, occurred in about 39% of patients in both study groups. There was no significant difference between groups in terms of this endpoint or the second co-primary endpoint, a composite score for HF care quality at the time of last follow-up.

"We were disappointed to find no difference," said Adam DeVore, MD, FACC, the study's lead author. "These principles of audit and feedback don't seem to improve upon what already exists in terms of quality improvement for [HF]. This strategy doesn't work above what we are already doing; we need to find other ones that do, and we have a lot of work ahead of us."

The trial is unique in its use of a randomized study design for a QI initiative. DeVore said that a patient panel helped inform the trial design, which researchers saw as a strength of the study. The trial was stopped early because of the COVID-19 pandemic and did not enroll as many patients as planned but was still adequately powered to reveal any differences between study groups, DeVore said.

DeVore and colleagues note that major gaps in guideline-directed care remain and that there continues to be a need to improve the quality of care for people with HF. He suggests that future interventions could employ digital and patient-facing tools or focus on care delivery outside of the hospital, such as at HF clinics.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: ACC Annual Scientific Session, ACC21, Heart Failure, Hospitals

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