QI measures increased evidence based therapies and reduced LOS for HF patients

Clinical Question

Does a national hospital-based quality initiative improve care in patients admitted with heart failure? (HF)

Bottom Line

Quality improvement tools improved adherence to HF treatment guidelines, which reduced length of stay and showed benefits in short-term mortality. (LOE = 2b)


Fonarow GC, Abraham WT, Albert NM, et al. Influence of a performance-improvement initiative on quality of care for patients hospitalized with heart failure. Results of the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). Arch Intern Med 2007;167:1493-1502.  [PMID:17646603]

Study Design

Cohort (prospective)




Inpatient (any location) with outpatient follow-up


OPTIMIZE-HF is a national hospital based quality improvement initiative aimed to improve adherence to evidence based guidelines and performance measures for patients hospitalized with HF. The program includes a hospital tool kit, quality-of-care reports, and educational initiatves. Data was submitted from 259 centers on 48,612 patients admitted with decompensated systolic or diastolic HF from the beginning of 2003 through 2004.. After implementation of the OPTIMIZE-HF program, adherence to recommended inpatient HF therapies significantly increased. Compliance with use of B-blockers, but not angiotensin converting enzyme inhibitors, at discharge was also improved. Mean length of stay decreased from 7.5 to 6.2 days (p < 0.001). The improvement in in-hospital mortality did not reach statistical significance (p = 0.06)