Review Article

Effectiveness of the Clinical Pathway in the Management of Congestive Heart Failure

Authors: Aparna Ranjan, MD, Leena Tarigopula, MD, Rakesh K. Srivastava, PhD, Olugbenga O. Obasanjo, MD, PhD, Eugene Obah, MD

Abstract

Background: The prevalence of congestive heart failure (CHF) in the United States is approximately 4 million, with associated annual health care expenditures exceeding $8 billion. Clinical pathways for CHF have been developed, but they have not been rigorously evaluated regarding efficacy and improvement in the quality of care. We sought to evaluate the effect of a CHF clinical pathway on hospital charges, length of stay, and use of angiotensin-converting enzyme (ACE) inhibitors in patients with CHF in a retrospective cohort study.

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References

1. Ho KK, Anderson KM, Kannel WB, Grossman W, Levy D. Survival after the onset of congestive heart failure in Framingham Heart Study subjects. Circulation 1993; 88: 107–115.
 
2. Agency for Health Care Policy and Research (AHCPR). Heart Failure: Evaluation and Care of Patients with Left-Ventricular Systolic Dysfunction(AHCPR Publication No. 94-0612). Rockville, MD, AHCPR, 1994.
 
3. Committee on Evaluation and Management of Heart Failure. Guidelines for the evaluation and management of heart failure: Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 1995; 26: 1376–1398.
 
4. Graves EJ. Detailed diagnoses and procedures, National Hospital Discharge Survey, 1990. Vital Health Stat 13 1992; 113: 1–225.
 
5. Ghali JK, Cooper R, Ford E. Trends in hospitalization rates for heart failure in the United States, 1973–1986: Evidence for increasing population prevalence. Arch Intern Med 1990; 150: 769–773.
 
6. Agency for Health Care Policy and Research (AHCPR). Heart Failure: Evaluation and Care of Patients with Left-Ventricular Systolic Dysfunction(AHCPR Publication No. 94-0613). Rockville, MD, AHCPR, 1994.
 
7. Graves EJ. National Hospital Discharge Survey: Annual summary, 1993. Vital Health Stat 13 1995; 121: 1–63.
 
8. Levit KR, Lazenby HC, Cowan CA, Letsch SW. National health expenditures, 1990. Health Care Financ Rev 1991; 13: 29–54.
 
9. O'Connell JB, Bristow MR. Economic impact of heart failure in the United States: Time for a different approach. J Heart Lung Transplant 1994; 13: S107–S112.
 
10. Venner GH, Seelbinder JS. Team management of congestive heart failure across the continuum. J Cardiovasc Nurs 1996; 10: 71–84.
 
11. Stafford RS, Saglam D, Blumenthal D. National patterns of angiotensin-converting enzyme inhibitor use in congestive heart failure. Arch Intern Med 1997; 157: 2460–2464.
 
12. Garg R, Yusuf S. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure: Collaborative Group on ACE Inhibitor Trials. JAMA 1995; 273: 1450–1456.