IMPROVE HF: Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting
- Conditions
- Myocardial InfarctionVentricular Dysfunction, LeftHeart Failure, Congestive
- Registration Number
- NCT00303979
- Lead Sponsor
- Medtronic Cardiac Rhythm and Heart Failure
- Brief Summary
The purpose of this study is to characterize current management of patients with either heart failure or prior myocardial infarction and left ventricular dysfunction and to assess the effect of education, specific clinical guidelines, reminder systems, comprehensive disease state management tools, benchmarked quality reports, and academic detailing on the use of evidence-based heart failure therapies in cardiology practices. This study is a quality improvement initiative that is being conducted through review of patient records.
- Detailed Description
IMPROVE HF, the largest US outpatient HF patient registry, has substantially contributed to our knowledge of how systolic HF and post MI left ventricular systolic dysfunction (LVSD) patients are treated in the outpatient setting.
The findings of IMPROVE HF clearly support this guideline and may help to establish a model framework for future performance improvement programs for outpatient cardiology practices.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 34810
- 18 years of age or older
- Primary or secondary diagnosis of heart failure or prior myocardial infarction (heart attack)
- Moderate-to-severe left ventricular dysfunction (LVD) as demonstrated by an ejection fraction < or = 35% and/or a qualitative assessment of LVD of moderate-to-severe or severe LVD
- Patient has been seen at the clinic at least twice in the past 2 years
- Patient received care from the physician participating in the study
- Patient has died
- Patient is not expected to survive for 12 months due to medical conditions other than heart failure
- Patient has undergone heart transplant surgery
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method To Evaluate Over the Aggregate IMPROVE-HF Practice Sites the Relative Changes in 7 Performance Measures at 24 Months Compared With Baseline and Determine the Number of Performance Measures That Achieved a Relative 20% or Greater Positive Change. 24 Month 7 performance measures: angiotensin converting enzyme inhibitor and/or angiotensin II receptor blockers (ACEI/ARB), beta-blokers, aldosterone receptor antagonists, anticoagulation for atrial fibrillation (AF), cardiac resynchronization therapy (CRT-P/CRT-D), cardioverter-defibrillator (ICD/CRT-D), heart failure (HF) education.
We first calcuated % of patients who were eligible for a performance measure that were treated by it at baseline and 24 months. We then calculated the relative change as (% treated at 24 months - % treated at baseline)/% treated at baseline. The 95% confidence interval (CI) was calculated and the relative change of each performance measure was evaluated using a z-test for one-sample proportion.
The number of performance measures with \>= 20% relative improvement was determined. The intervention was considered successful if a relative 20% or greater improvement in at least 2 of the 7 performance measures at 24 months compared with baseline was achieved.
- Secondary Outcome Measures
Name Time Method Observe the Change From Baseline to 24 Months in Each Performance Measure and Composite Score for the Aggregate Practices. 24 months performance measure improvement for each performance measure was analyzed at a practice level from baseline to 24 months. Performance measure adherence was calculated at the individual practice level and then combined and summarized. Mean, standard deviation, and 95% confidence intervals for performance measure adherence, composite score and relative change (24 months compared with baseline) are reported.
The Composite Score is based on the ratio of the sum of the numerators of all individual performance measures to the sum of the denominators of all individual performances measures. The numerator of a performance measure is the number of patients treated with that measure. The denomiator of a performance measure is the number of patients eligible for being treated with that measure.Observe the Relative Change Between Baseline of Cohort A and 18 Months of Cohort C in Performance Measures and Composite Score for the Aggregate Practices. baseline and 18 Months The relative changes between baseline of cohort A and 18 months of cohort C in performance measures and composite score for the aggregate practices were calculated using mean, standard deviation and 95% CI.
Observe the Number of Sites That Demonstrate a Relative 20% or Greater Improvement in 2 or More of the 7 Performance Measures at 24 Months as Compared to Baseline in Cohort A. 24 months The number of practices that achieved greater than or equal to 20% improvement in two or more of the 7 performance measures at 24 months as compared to baseline of cohort A is presented.
Observe the Relative Change Between Baseline of Cohort A and 6 Months of Cohort B in Performance Measures and Composite Score for the Aggregate Practices. Baseline and 6 Months The relative changes between baseline of cohort A and 6 months of cohort B in performance measures and composite score for the aggregate practices were calculated using mean, standard deviation and 95% CI.
Trial Locations
- Locations (138)
Northside Cardiology
🇺🇸Atlanta, Georgia, United States
Temecula Valley Cardiology
🇺🇸Murrieta, California, United States
University Cardiovascular Medical Group
🇺🇸Los Angeles, California, United States
Medical Center of the Rockies
🇺🇸Fort Collins, Colorado, United States
Connecticut Heart & Vascular Center
🇺🇸Bridgeport, Connecticut, United States
Mahesh Amin, MD PA
🇺🇸Clearwater, Florida, United States
Cardio-Pulmonary Associates
🇺🇸Monterey, California, United States
Cardiology PC
🇺🇸Syracuse, New York, United States
Primary Care Specialists Inc
🇺🇸Ayer, Massachusetts, United States
Drexel University College of Medicine
🇺🇸Philadelphia, Pennsylvania, United States
Missouri Cardiovascular Specialists
🇺🇸Columbia, Missouri, United States
Cardiovascular Consultants PC
🇺🇸Rochester, Michigan, United States
Tchefuncte Cardiovascular Associates,
🇺🇸Covington, Louisiana, United States
Clearwater Cardiovascular & Intervention
🇺🇸Clearwater, Florida, United States
Sutherland Clinic
🇺🇸Germantown, Tennessee, United States
Legacy Heart Center
🇺🇸Plano, Texas, United States
Florida Medical Clinic
🇺🇸Zephyrhills, Florida, United States
East Bay Cardiology
🇺🇸San Pablo, California, United States
Southcoast Cardiology
🇺🇸Savannah, Georgia, United States
Cardiac Associates of New Hampshire
🇺🇸Concord, New Hampshire, United States
Raleigh Cardiology
🇺🇸Raleigh, North Carolina, United States
Island Cardiac Specialist
🇺🇸Mineola, New York, United States
Cardiovascular Consultants of Kansas
🇺🇸Wichita, Kansas, United States
Northeast Georgia Heart Center
🇺🇸Gainesville, Georgia, United States
Cross County Cardiology
🇺🇸Edgewater, New Jersey, United States
Medicor
🇺🇸Bridgewater, New Jersey, United States
Eastside Cardiology, Roseville
🇺🇸Roseville, Michigan, United States
Harbor Medical AssociatesSo Weymouth
🇺🇸Weymouth, Massachusetts, United States
University Hospital Healthcare
🇺🇸Columbia, Missouri, United States
Cardiology Associates of Brooklyn
🇺🇸Brooklyn, New York, United States
United Medical Associates
🇺🇸Brooklyn, New York, United States
Cardiology Diagnostics, Ltd,
🇺🇸Saint Louis, Missouri, United States
Pasco Cardiology
🇺🇸Hudson, Florida, United States
Concorde Medical Group/NYU Hospital
🇺🇸Manhattan, New York, United States
Cardiovascular Consultants,
🇺🇸Tamarac, Florida, United States
Iowa Heart Center PC,
🇺🇸West Des Moines, Iowa, United States
Carolina Heart Specialists
🇺🇸Gastonia, North Carolina, United States
Heart-Lung Center
🇺🇸Hawthorne, New Jersey, United States
Hickory Cardiology
🇺🇸Hickory, North Carolina, United States
Cardiology of Atlanta
🇺🇸Atlanta, Georgia, United States
Diagnostic and Clinical Cardiologists
🇺🇸West Orange, New Jersey, United States
Blackstone Cardiology Associates
🇺🇸Pawtucket, Rhode Island, United States
Tidewater Heart Specialists, Inc.,
🇺🇸Hampton, Virginia, United States
Westchester Medical Group
🇺🇸Scarsdale, New York, United States
Dela Clinic
🇺🇸Lexington, Tennessee, United States
Columbia Cardiology Consultants
🇺🇸West Columbia, South Carolina, United States
Cardiology Associates of Lakeview
🇺🇸Fairfax, Virginia, United States
Gotham Cardiovascular Research
🇺🇸New York, New York, United States
Northeast Ohio Cardiovascular Specialists
🇺🇸Akron, Ohio, United States
Sanger Clinic
🇺🇸Charlotte, North Carolina, United States
Carolina Cardiology Associates
🇺🇸High Point, North Carolina, United States
North West Ohio Cardiology Consultants
🇺🇸Toledo, Ohio, United States
The Heart Group, Ltd
🇺🇸Lancaster, Pennsylvania, United States
Cardiovascular Clinic, Inc.
🇺🇸Parma, Ohio, United States
The Cardiovascular Group
🇺🇸Fairfax, Virginia, United States
Cardiology Associates of Southeastern PA
🇺🇸Wynnewood, Pennsylvania, United States
Bryce Morrice MD and Debra Heldman MD Inc
🇺🇸Newark, Ohio, United States
Tyler Cardiovascular Consultants
🇺🇸Tyler, Texas, United States
University Associates in Cardiology
🇺🇸Burlington, Vermont, United States
Abington Medical Specialists
🇺🇸Abington, Pennsylvania, United States
Schuster Cardiology Associates
🇺🇸Kettering, Ohio, United States
Geisinger Medical Center
🇺🇸Danville, Pennsylvania, United States
Heart and Vascular Center of Bradenton
🇺🇸Bradenton, Florida, United States
York Hospital
🇺🇸York, Pennsylvania, United States
Heart Place North Arlington
🇺🇸Arlington, Texas, United States
Cardiovascular Associates
🇺🇸Kissimmee, Florida, United States
Owensboro Heart and Vascular
🇺🇸Owensboro, Kentucky, United States
Southeastern Heart and Vascular
🇺🇸Greensboro, North Carolina, United States
Cardiovascular Associates of Glenbrook and Evanston, LLC
🇺🇸Glenview, Illinois, United States
Freeman Heart Institute
🇺🇸Joplin, Missouri, United States
Southern New Jersey Cardiac Specialists
🇺🇸Voorhees, New Jersey, United States
Peninsula Cardiology
🇺🇸Salisbury, Maryland, United States
Heart Center of Southern Maryland
🇺🇸Clinton, Maryland, United States
Arundel Heart Associates
🇺🇸Glen Burnie, Maryland, United States
Muhammed H. Zahra
🇺🇸Cleveland, Ohio, United States
Cleveland Clinic Foundation
🇺🇸Cleveland, Ohio, United States
Doctors Hospital Heart Failure Clinic
🇺🇸Columbus, Ohio, United States
Miami Cardiology Group
🇺🇸Miami, Florida, United States
St. Vincent's Hospital
🇺🇸Indianapolis, Indiana, United States
Methodist Hospital
🇺🇸Indianapolis, Indiana, United States
St. Vincent's Hospital Indianapolis
🇺🇸Indianapolis, Indiana, United States
Comprehensive Heart Care, PA
🇺🇸Houston, Texas, United States
Cardiology Consultants of Houston
🇺🇸Houston, Texas, United States
Cardiology Clinic of San Antonio
🇺🇸San Antonio, Texas, United States
Wilford Hall Medical Center
🇺🇸San Antonio, Texas, United States
Mid America Cardiology
🇺🇸Kansas City, Kansas, United States
Cardiology Consultants
🇺🇸Topeka, Kansas, United States
California Pacific Cardiovascular Medical
🇺🇸San Francisco, California, United States
University of Mississippi Medical Center
🇺🇸Jackson, Mississippi, United States
Dartmouth-Hitchcock Medical Center
🇺🇸Lebanon, New Hampshire, United States
Mercy Cardiology
🇺🇸Saint Louis, Missouri, United States
Cardiovascular Associates of Montclair
🇺🇸Birmingham, Alabama, United States
Maryland Heart, PC
🇺🇸Bethesda, Maryland, United States
Island Cardiac Specialists
🇺🇸Mineola, New York, United States
St. Vincent's Hospital,
🇺🇸Indianapolis, Indiana, United States
Indian River Cardiovascular Associate
🇺🇸Vero Beach, Florida, United States
Heart Center of Eastern Carolina
🇺🇸New Bern, North Carolina, United States
Pinehurst Cardiology Consultants
🇺🇸Pinehurst, North Carolina, United States
Vazzana and Bogin Cardiology Associates
🇺🇸Staten Island, New York, United States
Cardiology Associates
🇺🇸Myrtle Beach, South Carolina, United States
Cardiovascular Associates of Mesa
🇺🇸Mesa, Arizona, United States
Heart Care, PC
🇺🇸Scottsdale, Arizona, United States
Southern Arizona VA Health Care System
🇺🇸Tucson, Arizona, United States
Central Arkansas Cardiovascular Institute
🇺🇸Hot Springs, Arkansas, United States
St. Jude Heritage Medical Group
🇺🇸Fullerton, California, United States
Veterans Administration Hospital
🇺🇸Los Angeles, California, United States
Arkansas Cardiology Clinic
🇺🇸Little Rock, Arkansas, United States
OMNI
🇺🇸Melbourne, Florida, United States
Scripps Clinic Green Hospital
🇺🇸La Jolla, California, United States
Cardiology Consultants Medical Group
🇺🇸Tarzana, California, United States
Clark and Daughtrey Medical Group
🇺🇸Lakeland, Florida, United States
Cardiology Consultants, PA
🇺🇸Spartanburg, South Carolina, United States
St. Luke's Idaho Cardiology Associates
🇺🇸Boise, Idaho, United States
MidAmerica Cardiovascular Consultants
🇺🇸Frankfort, Illinois, United States
Heart Care Center of Illinois
🇺🇸Blue Island, Illinois, United States
Heart Clinic of Louisiana
🇺🇸Marrero, Louisiana, United States
Consultants in Cardiology
🇺🇸Farmington Hills, Michigan, United States
St. Paul Cardiology
🇺🇸Saint Paul, Minnesota, United States
Merrimack Valley Cardiology
🇺🇸Chelmsford, Massachusetts, United States
SUNY Downstate Medical Center
🇺🇸Brooklyn, New York, United States
Westwood Cardiology
🇺🇸Westwood, New Jersey, United States
Albany Associates in Cardiology,
🇺🇸Albany, New York, United States
Southbay Cardiology
🇺🇸West Islip, New York, United States
Meritcare Medical Center
🇺🇸Fargo, North Dakota, United States
Asheville Cardiology Associates
🇺🇸Asheville, North Carolina, United States
Heart Center of Eastern Carolina,
🇺🇸New Bern, North Carolina, United States
The Heart Institute of Northwest Ohio
🇺🇸Lima, Ohio, United States
Central Bucks Specialists, Ltd.,
🇺🇸Doylestown, Pennsylvania, United States
Associated Cardiologists
🇺🇸Harrisburg, Pennsylvania, United States
Sumter Medical Consultants
🇺🇸Sumter, South Carolina, United States
Upstate Cardiology
🇺🇸Greenville, South Carolina, United States
University of Texas South Western Medical Center at Dallas
🇺🇸Dallas, Texas, United States
Cardiology Associates of Green Bay
🇺🇸Green Bay, Wisconsin, United States
Florida Heart Group
🇺🇸Orlando, Florida, United States
Louisville Cardiology Medical Group P.S
🇺🇸Louisville, Kentucky, United States
Medical Center Cardiologists P.S.C
🇺🇸Louisville, Kentucky, United States
Medical University of South
🇺🇸Charleston, South Carolina, United States
Pacific Cardiology
🇺🇸Honolulu, Hawaii, United States