Adherence to practice guidelines and heart failure patient outcomes before and after implementation of the HEARTFELT (HEART Failure Effectiveness and Leadership Team) intervention

HEARTFELT is a multifaceted intervention designed to improve adherence with the American College of Cardiology/American Heart Association practice guidelines for heart failure. The purpose of this research study was to assess differences in clinician outcomes (knowledge and guideline adherence) and the outcomes of elderly patients diagnosed with heart failure (length of stay and use of emergent services) before and after implementation of the HEARTFELT intervention.;A quasi-experimental, untreated control group design with separate pretest/posttest samples was employed at a community hospital in Connecticut to answer the research questions. The untreated historical control group included patients age 65 and older with the diagnosis of heart failure and a nonequivalent comparison group of patients with the diagnosis of stroke. The posttest samples included patients with the diagnosis of heart failure and stroke admitted after implementation of HEARTFELT. The HEARTFELT intervention includes the following components: an automated clinical pathway integrated with evidence-based guideline recommendations, clinician access to evidence, a heart failure patient self-management information form, discharge orders and patient self-management education form. Data were analyzed using parametric and nonparametric methods.;Findings indicate that the HEARTFELT intervention had a significant impact on some clinician outcomes, but not on patient outcomes. Significant improvement was noted in clinician adherence with addressing all self-management categories in the EMR and clinician adherence to practice guideline recommendations related to self-management education given to the patient in writing at discharge. In addition, registered nurse knowledge of guideline recommendations and physician knowledge of type three guideline recommendations improved significantly from the pretreatment to the post-treatment period.;While guideline adherence is associated with less practice variation and improved processes, methods of integration into practice in community hospital settings has been largely unexplored. The multifaceted HEARTFELT intervention shows promise towards use of informatics processes to integrate evidence at the point of care, reduce unwarranted variation in practice, improve clinician adherence with practice guidelines and ultimately improve the outcomes of individuals with heart failure.