Health Services and Outcomes Research Associations between Outpatient Heart Failure Process-of-care Measures and Mortality Editorial See P 1581 Clinical Perspective on P 1610 Hf Outpatient Process Measures Longitudinal Follow-up Statistical Methods Results Baseline Patient Characteristics Practice C

Background—Assessment of the quality of care for outpatients with heart failure (HF) has focused on the development and use of process-based performance measures, with the supposition that these care process measures are associated with clinical outcomes. However, this association has not been evaluated for current and emerging outpatient HF measures. Methods and Results—Performance on 7 HF process measures (4 current and 3 emerging) and 2 summary measures was assessed at baseline in patients from 167 US outpatient cardiology practices with patients prospectively followed up for 24 months. Participants included 15 177 patients with reduced left ventricular ejection fraction (Յ35%) and chronic HF or post–myocardial infarction. Multivariable analyses were performed to assess the process-outcome relationship for each measure in eligible patients. Vital status was available for 11 621 patients. The mortality rate at 24 months was 22.1%. Angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, ␤-blocker use, anticoagulant therapy for atrial fibrillation, cardiac resynchronization therapy, implantable cardioverter-defibrillators, and HF education for eligible patients were each independently associated with improved 24-month survival, whereas aldosterone antagonist use was not. The all-or-none and composite care summary measures were also independently associated with improved survival. Each 10% improvement in composite care was associated with a 13% lower odds of 24-month mortality (adjusted odds ratio, 0.87; 95% confidence interval, 0.84 to 0.90; PϽ0.0001). Conclusions—Current and emerging outpatient HF process measures are positively associated with patient survival. These HF measures may be useful for assessing and improving HF care. H eart failure (HF) is a substantial cause of morbidity, mortality, and healthcare expenditures. 1,2 Despite this burden, quality of HF care varies considerably, and there is a significant lag between the incorporation of clinical trial evidence into professional guidelines and delivery of evidence-based care. 3–5 Professional societies, healthcare payers, government agencies, and accreditation organizations have instituted programs to facilitate improvements in clinical care for patients with HF. A major component of these efforts is the development and implementation of standard, guideline-based, process-of-care performance measures that provide a mechanism through which the quality of HF care can be measured and improved. 6 Selection of appropriate process-of-care measures for use in quality improvement, public profiling, or financial incentives is critically important, with potential implications for patient outcomes, the health-care system, and administrative burden. 7 In prior studies of inpatient HF performance measures, some, but not all, process-of-care measures were associated with postdischarge clinical outcomes. 8 –12 These studies have …