Quality Indicators for the Care of Heart Failure in Vulnerable Elders
Published in: Journal of the American Geriatrics Society, v. 55, no. s2, suppl., Oct. 2007, p. S340-S346
Posted on RAND.org on October 01, 2007
Heart failure is a common and morbid disease. There are an estimated 5 million patients in the United States with heart failure, and approximately 550,000 patients are newly diagnosed each year. Half of patients with a diagnosis die within 4 years, and 50% of those with severe heart failure die within 1 year. Heart failure is a disease of older adults, with a mean age of 74 for the affected population. Approximately 80% of those hospitalized with heart failure are aged 65 and older, and the incidence in this age group approaches 1% per year. Fortunately, randomized trials have identified several therapies that benefit patients with heart failure. Angiotensin-converting enzyme (ACE) inhibitors and beta-blockers were shown to prolong survival in the 1990s, and clinical guidelines have recommended these treatments for many years. In addition, other processes of care not necessarily evaluated in randomized trials but with considerable justification are now viewed as indicators of quality. Improving the quality of care for vulnerable elders (VEs) will likely lead to significant improvements in morbidity and mortality, given that VEs are at high risk from heart failure. Fourteen quality indicators (QIs) for the management of heart failure in VEs were selected in 1999 as part of the Assessing the Care of Vulnerable Elders (ACOVE) project. Since that publication, several new therapies have been shown to be life prolonging for patients with heart failure. The purpose of this article is to review and update the ACOVE QIs for heart failure in VEs.