Quality of Healthcare in Acute Heart Failure Management in a Tertiary Hospital

Abstract

Background: Acute heart failure (AHF) often requires hospitalization for optimal management and the quality of healthcare (QOHC)  depends on the implementation of key  quality indicators (KQI). However, the QOHC in AHF  patients is not established in our locale. We  therefore sought to  determine the QOHC in hospitalized AHF patients in a tertiary  health center.

Methods: It was a retrospective study of hospitalized AHF patients in a tertiary center. Demographic, and clinical data were extracted from the records. The QOHC was determined by the frequency of implementation of KQI in cases recommended for the KQI. Suboptimal, and optimal QOHC were determined by a mean frequency of less than 100%, and 100% respectively.

Results: Seventy nine cases of AHF were managed in the general wards. The mean age was 60.49 ± 17.42 years, and 41 (51.9%) were males. Fifty cases (63.3%) had heart failure with reduced ejection fraction. The frequencies of KQI implementation were left ventricular ejection fraction assessment 70 (88.8%), use of Angiotensin converting enzyme  inhibitors (ACEI)/Angiotensin receptor blockers (ARB) 39  (78%), Beta Blockers 36 (72%), anticoagulant 10 (90.9%),  patient education 0(0%), and scheduled appointment 71  (89.9%). The mean  frequency was 69.9%. Fifty-five (69.7%),  and 24 (30.3%) of cases had optimal and suboptimal QOHC  respectively. Blood pressure, and  duration of hospitalization  differed in both groups, p values of 0.000, and 0.016  respectively.

Conclusion: The QOHC in hospitalized AHF patients is  suboptimal in terms of usage of guideline directed medical  therapy (GDMT), lack of patient education, and poor  infrastructure. Measures to address these problems should be  initiated.