Evidence-Based Answers

Evidence Central™ is an integrated web and mobile solution that helps clinicians quickly answer etiology, diagnosis, treatment, and prognosis questions using the latest evidence-based research.


Evidence Central for Mobile Devices

Evidence Central iOS iPhone iPad Android

Evidence Central from Unbound Medicine, available for iOS® and Android™, is optimized for each platform and features superior navigation, so answers are easy to find at the bedside or anywhere they’re needed. Learn More

Word of the Day

Compliance with heart failure performance measures not associated with improved outcomes

Clinical Question:
Does hospital compliance with the 4 performance measures for patients hospitalized with heart failure improve 30-day mortality and readmission rates?

Bottom Line:
Hospital compliance with performance measures published by the American College of Cardiology (ACC) and the American Heart Association (AHA) for the treatment of patients hospitalized with heart failure (HF) is high. However, strong compliance is not associated with decreased mortality or reduced readmission rates. Hospital-specific factors such as location in areas with higher socioeconomic status or higher volumes of HF patients are better predictors of decreased mortality. (LOE = 2b)

Schopfer DW, Whooley MA, Stamos TD. Hospital compliance with performance measures and 30-day outcomes in patients with heart failure. Am Heart J 2012;164(1):80-86.  [PMID:22795286]

Study Design:
Cohort (retrospective)

Self-funded or unfunded


Inpatient (any location) with outpatient follow-up

The ACC and the AHA have published 4 performance measures designed to measure and improve quality of care for patients hospitalized with HF: (1) evaluation of left ventricular [LV] systolic function, (2) administration of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers for LV dysfunction, (3) provision of smoking cessation counseling, and (4) provision of discharge instructions. These authors investigated whether compliance with these measures improves 30-day mortality and readmission. Using the US Department of Health and Human Services Hospital Compare database, the authors identified 3665 hospitals that treat HF patients. Of this group, compliance with the 4 performance measures was high (94%; interquartile range = 88%-97%). After adjusting for factors including patient demographics, socioeconomic factors, hospital volume, and type of hospital, there were no differences detected in 30-day mortality or readmission rates between hospitals in the top 25% and all others. When each individual performance measure was assessed, only compliance with evaluation of LV function was associated with decreased 30-day mortality. Both evaluation of LV function and smoking cessation counseling were associated with decreased 30-day readmission rates. Although no association was found between compliance with performance measures and 30-day outcomes, the authors did find that hospitals located in areas with higher household income and those with a greater volume of HF admissions had decreased mortality rates.


Site Licenses

Site license

Site Licenses are available for schools, universities, hospitals, government agencies, and companies. For more information, contact us.