Programme no. 556-P
Quality Improvement
Improving diagnosis and treatment of heart failure (HF) in general practice. A cluster randomized educational intervention. Study protocol.
Bjørn Gjelsvik*1, Lars Gullestad2, Svein Gjelstad3, Jørund Straand4
1Department of General Practice,Institute for Health and Society, University of Oslo,0317 Oslo,Norway, 2Department of cardiology Rikshospitalet,Oslo University Hospital,Oslo,Norway, 3Department of General Practice,Institute for Health and Society, University of Oslo,0317 Oslo,Norway, 4Department of General Practice,Institute for Health and Society, University of Oslo,0317 Oslo,Norway
* = Presenting author
Objectives: By implementing evidence based HF guidelines in primary care we aim to improve the quality of care for HF patients in primary care.
Background: Heart failure (HF) is a major cause of morbidity and mortality among the elderly. Several studies indicate a general underutilization of evidence-based life-prolonging treatment.
Results: Main outcome measures: As compared with control group, utilization of evidence based medication, use of diagnostic tools, hospital admission rates for heart failure, total mortality:

Primary outcome as assessed after one year of intervention: Proportion (%) of HF patients using an ACE-inhibitor (ACEI) (or an angiotensin receptor blocker-ARB) and a betablocker (BB) in combination.

Secondary outcomes after one year: % of HF patients on ACEI/ ARB, BB, aldosteronblocker or diuretics, alone or in combination, % of HF patients on recommended target dose on drugs above, % of HF patients using potential harmful/contraindicated drugs for HF, % of HF patients having had echocardiography as part of diagnostic workup, % of HF patients having measured BNP/NT-proBNP as part of diagnostic workup, % of HF patients with left bundle branch block (LBBB) scheduled for evaluation of cardiac resynchronization therapy (CRT), % of HF patients where control of potassium and creatinine have been performed.

Tertiary outcome (outcome during extended follow up): Patient HF-related hospital admission rates, Patient’s all-cause mortality.

Material/Methods: A multifaceted educational intervention based on general practitioners’ (GP)s' Continuous Medical Education (CME) groups. The methods are by large based on the previous Norwegian Rx-PAD intervention. We aim to include about 150 GPs from three different health regions (corresponding to about 2,250 patients with HF), half of which will be randomized to the intervention group and the other half to the control group. The control group will receive another educational intervention (improving primary prevention of cardiovascular disease). The educational intervention consists of CME courses, audit reports to the individual GPs (based on data from electronic patient records, EPR), which will subsequently be discussed with peers in the CME group setting. The interface between hospital care and general practice will in particular be highlighted.
Conclusion: The project is still under planning, and we want to discuss its objectives and methods with Nordic colleagues. The project is practice-based and highly relevant for general practice.
Points for discussion: Are the listed outcome measures relevant as quality indicators for HF care in general practice?