Congestive Heart Failure and Physician Compliance: A Retrospective Review of Guideline Implementation in a Rural Teaching Hospital

Abstract

Congestive Heart Failure (CHF) is a complex condition affecting 1.5% to 2% of the American population. Despite increasing developments in treatment, the costs associated with the disease continue to rise, accounting for $10 billion per year in management costs. To help physicians manage patients with CHF, the American Heart Association released guidelines outlining the proper treatment regimen. Implementation of these guidelines should lead to a reduction in the mortality rate, an increase in patient quality of life, and a reduction in total cost of management. We set out to investigate the compliance to these national guidelines for physicians within the Guthrie Healthcare System. We reviewed 340 patients within the system from July 1999 to January 2001. Patients were selected who had a CHF-related diagnosis and had an ejection fraction <40%, diagnosed by echocardiogram, MUGA scan, or cardiac catheterization. Males had a higher incidence of CHF (p < .001). Of patients diagnosed with CHF, males were significantly younger than females (p = .003). Physicians were considered to be compliant if they placed these patients on a regimen that included ACE inhibitors, angiotensin II receptor blockers, or a combination of hydralazine and nitrate. Overall compliance with guidelines was 78.5%. Across practitioner types, cardiologists were the most compliant (p = .03). Based upon the overall high rate of compliance, we are pleased that the integration of the national CHF guidelines into practice has been successful.