Congestive Heart Failure Clinical Outcomes Study in a Private Community Medical Group

Louis A. Civitarese, DO, and Nicholas DeGregorio, MD,


J Am Board Fam Med. 1999;12(6) 

In This Article


The data from the study audits are displayed in Table 1 . Two hundred seventy-five patients were included in the study. During the study the total patient population increased, but the patient demographics remained unchanged. The percentage of patients admitted to the hospital with documented left ventricular function did not change considerably during the study. Ninety-two percent of patients were characterized as having systolic or diastolic dysfunction, whereas this condition was not determined in approximately 8% of patients. The percentage of patients on ACE inhibitor therapy, as well as ACE inhibitor dosages upon admission, remained relatively constant throughout the study. By the end of the study, however, 100% of patients with confirmed systolic dysfunction were either discharged with prescriptions for ACE inhibitors or had documentation that they met exclusion criteria for ACE inhibitor therapy.

Using logistic regression analysis, we found that during the study there was a significant decrease in the percentage of systolic congestive heart failure admissions with time P = .0279 (Figure 1). There was a 49% reduction in the absolute number of patients admitted for congestive heart failure caused by systolic dysfunction throughout the study (P = .0367). The absolute number of patients admitted with diastolic dysfunction remained steady throughout the study. By the end of the study, however, diastolic dysfunction accounted for a substantially larger percentage of all congestive heart failure admissions. Documentation of diet and self-weighing instructions to patients was suboptimal.

Percentage of patients admitted with congestive heart failure with systolic dysfunction, by quarter.

Although this study was hospital-based, the congestive heart failure guideline was emphasized and made available to physicians in their offices as well as the hospital. We believe that an increase in the outpatient use of ACE inhibitor therapy for congestive heart failure was a major contributor to the reduction in hospital admissions for that diagnosis. This belief was strongly supported by outpatient pharmacy utilization data from Aetna US Healthcare, which showed a 39% increase in ACE inhibitor use by patients with congestive heart failure who were cared for by physicians in our group during the course of this study.[12]