Reviwer: Dr. Muhammet Dural

Name of the Study: Effect of a Hospital and Postdischarge Quality Improvement Intervention on Clinical Outcomes and Quality of Care for Patients With Heart Failure With Reduced Ejection Fraction: The CONNECT-HF

Published in Congress: ACC 2021

Full Text Link: https://jamanetwork.com/journals/jama/article-abstract/2782302, https://www.acc.org/Latest-in-Cardiology/Articles/2021/05/12/19/40/Mon-8am-CONNECT-HF-acc-2021

Background:  Currently, recurrent hospitalization and death rates are still high in patients with reduced ejection fraction heart failure (HFrEF). In addition, the rate of use of guideline-directed medical treatment is not at the desired level. There is limited data on the effectiveness of in-hospital and post-discharge quality improvement intervention. In CONNECT-HF study, the quality improvement intervention applied in hospital and after discharge in patients with HFrEF was compared with the usual care approach.

Objective : In the CONNECT-HF study, it was aimed to compare the quality improvement intervention applied in hospital and after discharge with the usual care approach and to examine its effect on heart failure outcomes in patients with HFrEF.

Method: The study included 161 hospitals in US with annual follow-up of ≥50 patients with acute heart failure. 5647 patients with ejection fraction ≤40% presenting with acute decompensated heart failure were enrolled to the study. Patients were randomized 1:1 to either quality improvement intervention (n=2675) versus those with usual care (n=2972). The follow-up period was 12-months. Re-hospitalization due to heart failure or death and change in quality score were identified as primary outcomes.

Results: Re-hospitalization due to heart failure or death was found to be similar in both groups [HR 0.92 (0.81 to 1.05) P=0.21]. There was no significant difference between the two groups in the change in composite quality score (adjusted odds ratio, 1.06 [95% CI, 0.93 to 1.21]).

Conclusion: In HFrEF patients, it has been found that quality improvement intervention focused on the supervision of heart failure care, feedback and clinician training did not provide a significant improvement in heart failure outcomes.

Interpretation: It is known that the rate of applying guideline-directed medical treatment is still low in patients with HFrEF. First of all, optimal medical treatment should be applied individually. Maybe different results can be obtained in future studies with the arrangements to be made in quality improvement programs. As a result, guideline-directed treatment at appropriate dose should be applied to the appropriate patient, and follow-up methods should be done meticulously.