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    Improving Care for Patients Hospitalized with Heart Failure

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    Author
    Sisterman, Kathryn
    Issue Date
    2017
    Keywords
    Guideline Directed Medical Therapy
    Heart Failure
    Advisor
    Badger, Terry
    
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    Publisher
    The University of Arizona.
    Rights
    Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
    Abstract
    Background: Heart failure is a clinical syndrome occurring from the heart’s inability to effectively fill and or pump blood, it is the most common reason for admission in elderly patients. Guideline directed medical therapy refers to implementation of all class I agents to reduce patient morbidity and mortality, unless there is an appropriate contraindication. Appropriate beta blocker (BB), angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), and aldosterone antagonist (AA) are recommended to be prescribed together prior to discharge for a hospital admission for decompensated heart failure with reduced ejection fraction (HFrEF). Get With The Guidelines – Heart Failure (GWTG- HF) is an online quality improvement project that assists hospitals in providing guideline directed care. Objective: The purpose of this study was to determine if implementation of the GWTG-HF program, increases provider adherence to guideline directed medical therapy (GDMT) for patients admitted with a primary diagnosis of decompensated HFrEF at Banner University Medical Center Tucson (BUMCT). Design: This is a quality improvement project with a pre and post test descriptive design. Setting: BUMCT from 10/04/17 – 11/08/17 Participants: Fifty-five patients discharged with the primary diagnosis of decompensated HFrEF Measurements: Baseline guideline adherence for a 30-day period was compared to guideline adherence after the initiation of the GWTG-HF program. Results: The 24 patients pre intervention were compared to 31 patients post intervention. The following results were found when comparing pre and post adherence rates: BB adherence 92% versus 100%, ACEI/ARB adherence 100% versus 94%, AA adherence 67% versus 84%, and guideline directed medical therapy 58% versus 81%. There were no statistically significant differences for the pre and post adherence rates. Conclusion: Although, there were no statistically significant differences found to support that implementation of the GWTG-HF program, increases providers adherence to GDMT for patients admitted with a primary diagnosis of decompensated HFrEF, the trends were clear. In three out of four class I agents, there was an increase in appropriate provider prescribing per the guidelines.
    Type
    text
    Electronic Dissertation
    Degree Name
    D.N.P.
    Degree Level
    doctoral
    Degree Program
    Graduate College
    Nursing
    Degree Grantor
    University of Arizona
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