Multiregional Implementation Initiative's Impact on Guideline-Based Performance Measures for Patients Hospitalized With Heart Failure: IMPLEMENT-HF.

Abstract

Background: Despite randomized data for survival benefit (with class 1 recommendations) for treating heart failure (HF) with reduced ejection fraction using quadruple medical therapy (QMT)-defined as evidence-based β-blockers, sodium-glucose cotransporter 2 inhibitor, preferably angiotensin receptor/neprilysin inhibitor, and mineralocorticoid receptor antagonist-it is underutilized. IMPLEMENT-HF is a multiregional HF quality improvement initiative to improve care and outcomes for patients with HF by enhancing the use of QMT in routine practice.

Methods: This analysis of HF with reduced ejection fraction treatment in patients from hospitals participating in the American Heart Association's Get With The Guidelines-HF who volunteered to participate in IMPLEMENT-HF in 7 US regions. IMPLEMENT-HF included multidisciplinary learning to share strategies for formulary changes, electronic health record tools, and patient resources with site-level feedback reports. Participants gathered QMT data at discharge and 30 days after discharge. We evaluated QMT utilization and variation, in addition to other prespecified performance measures, from Q1 2021 to Q2 2023.

Results: The median (interquartile range) age of 43 558 admitted patients at 61 hospitals was 74 (63-83) years; 16 530 (38%) belonged to racial and ethnic minorities, and 22 228 (51%) were women. Between Q1 2021 and Q2 2023, defect-free QMT improved from 4.7% to 44.6% at discharge and from 0% to 44.8% at 30 days (both P<0.0001). There was also substantially improved incorporation of health-related social needs assessments. The magnitude of improvements was similar when stratified by sex or race and ethnicity, yet there was significant regional variation.

Conclusions: Among healthcare systems participating in IMPLEMENT-HF, there was a marked increase in QMT use among eligible patients over the course of the initiative. This quality improvement initiative supports a learning collaborative model to promote improvements in QMT use.