For more information about heart failure and other forms of advanced heart disease, please click here.
Advanced Technology for Heart Failure
CRT: Cardiac Resynchronization Therapy. CRT is a technique that uses a bi-ventricular pacemaker to synchronize the contraction of the bottom chambers of the heart, improving pumping action and reducing heart failure symptoms. According to study results published in the New England Journal of Medicine, (May, 2004: 350(21); 2140-2150), persons with advanced heart failure have a reduced risk of death and disability when CRT is used in conjunction with implantable defibrillator therapy.
ICD: Internal Cardioverter Defibrillator. Not all persons with heart failure meet the specific criteria for CRT, and it does not replace the need for heart failure medications. Many who qualify for CRT may also benefit from having an ICD, which monitors the heart rhythm continuously and delivers therapy in the form of fast pacing or shocks as needed.
Other advanced care for heart failure available at BWH include: high-risk revascularization, advanced valve surgery, assist device therapy, disease management, and transplant.
At Brigham and Women's Hospital, advanced therapies are available for persons with heart failure.
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Inpatient Mortality
Mortality rate (measured as a percentage) provides general information about the quality of care delivery, and can be an important quality indicator. However, some hospitals care for patients with a greater severity of illness and therefore may have a higher mortality rate. Based on a large sample of university hospitals (data from the University Healthsystem Consortium, aka UHC), the national average mortality rate for heart failure 2.51%. Because BWH patients are generally more sick than the average patient, our expected mortality rate for heart failure is 3.37% (as estimated by UHC).
The inpatient mortality rate for heart failure at Brigham and Women's Hospital is 1.95%, which is better than both the national (2.51%) and expected (3.37%) rates. All rates refer to the 12-month period ending 6/30/07.
30-Day All Causes Mortality Rate
The Centers for Medicare and Medicaid (CMS) have done an analysis of 30-day all cause mortality, following an admission for heart failure. CMS derived the 30-Day Risk-Adjusted Mortality measures from their own data about patients on Medicare and the hospitals that treat them. Hospitals were classified as "Better", "Worse", or "No Different" than the U.S. National Rate. For information about other hospitals' performance, go to the Hospital Compare website.
Brigham and Women's Hospital was one of only 3 hospitals in Massachusetts and 38 hospital nationwide to be classified as "Better Than the US National Rate" for hospital 30-day risk-adjusted heart failure mortality.
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Angiotensin Converting Enzyme Inhibitor (ACEI) or Angiotensin Receptor Blocker (ARB) Prescribed at Discharge
According to the Agency for Healthcare Research and Quality: “Routine lifelong use of an ACEI or ARB is recommended for heart failure patients with depressed ejection fraction (when the heart's bottom left chamber pumps 40 percent or less blood to the rest of the body), unless such use is contraindicated. Yet, a new study shows that nearly half of heart failure patients and one-third of those with depressed ejection fraction were not prescribed an ACEI on hospital discharge. Almost one-third of patients who were discharged with ACEI's had stopped taking them within a year. Considering that almost 50% of heart failure patients are readmitted to the hospital within 6 months of discharge, underuse of ACEI's is a significant problem” (Journal of the American College of Cardiology, June 2, 2004: 43(11); 2036-2043).
94% of patients with heart failure at Brigham and Women's Hospital received a discharge prescription for an ACEI or ARB medication unless otherwise contraindicated in 2007 (fiscal year to date).
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Condition Specific Instructions at Discharge
According to the Heart Failure (HF) Society of America, heart failure is a chronic condition in which the heart’s pumping ability is impaired, causing any combination of the following symptoms: fatigue, shortness of breath, and swelling in the ankles and legs. With proper medication and lifestyle changes, however, persons with heart failure may live longer and feel better. Because HF is a complex condition, persons with heart failure and their family members will need to continue life-long learning about the condition and treatments used to keep HF patients stable and out of the hospital.
According to the Joint Commission on Accreditation of Healthcare Organizations, persons with heart failure benefit from discharge instructions that include information on activity level, diet, discharge medications, follow-up appointments, weight monitoring, and what to do if symptoms worsen. Hospital readmissions are common in persons with heart failure and educating patients and family members is crucial to successful heart failure management. Scientific evidence supports condition-specific discharge planning and post-discharge support to optimize heart failure self-management and prevent readmission.
At Brigham and Women's Hospital, 86% of patients with heart failure received discharge instructions on activity, diet, medications, follow up, weight monitoring, and symptom management in 2007 (fiscal year to date). BWH also has an award-winning disease management program run by skilled nurse practitioners.
Left Ventricular Function Assessment
The left ventricle (LV) of the heart is the chamber that pumps blood to the rest of the body. LV function is often, but not always, impaired in persons with heart failure. The Joint Commission on Accreditation of Hospitals, in conjunction with the American College of Cardiology and American Heart Association, therefore, recommends LV assessment as a key diagnostic test for persons with suspected heart failure.
The most common test to assess LV function is the echocardiogram, or "echo." This test helps the physician determine how the heart is affected. There are three main parts of the heart that may be affected. The muscle (myocardium), valves, or covering (pericardium) may be affected, contributing to heart failure symptoms according to the American College of Cardiology and American Heart Association Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult. A measure called the left ventricular ejection fraction or LVEF is used to check for damage due to heart attacks and other conditions. The LVEF value for a person with no heart damage is usually around 60 percent or greater. Systolic dysfunction (condition that causes reduced pumping ability of the heart’s left lower ventricle) represents reduced pumping ability of the heart.
At Brigham and Women's Hospital, 99% of heart failure patients received a left ventricular function assessment in 2007 (fiscal year to date).
Smoking Cessation Advice
Smoking is a modifiable risk factor for heart disease. National guidelines strongly recommend smoking counseling to help persons with heart disease to quit smoking. (National Cancer Institute Prevention and Cessation of Cigarette Smoking: Control of Tobacco Use). Tobacco Cessation Guidelines from the United States Department of Health and Human Services provide helpful tips on smoking cessation for patients.
At Brigham and Women's Hospital, 100% of eligible heart failure patients received referrals for smoking cessation counseling prior to discharge in 2007 (fiscal year to date).
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Quality Measures for Other Cardiovascular Procedures & Diseases:
Abdominal Aortic Aneurysm (AAA)
Carotid Endarterectomy (CEA)
Coronary Artery Bypass Graft (CABG)
Myocardial Infarction (Heart Attack)
Percutaneous Coronary Intervention (PCI)
Peripheral Artery Disease (PAD)
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