Practice-level compliance with the heart failure (HF) composite measure as well as individual measures related to beta-blocker and ACE inhibitor/ARB use were associated with decreased risk of death or hospitalization, according to a recent study published in American Heart Journal.

Paul L. Hess, MD, MHS, et al., investigated the association between real-world outcomes and practice-level performance in the outpatient care setting. To do so, they included patients (age ≥65 years) diagnosed with atrial fibrillation (AFib), coronary artery disease (CAD), HF and/or hypertension at centers participating in the NCDR PINNACLE Registry in 2016. Registry data was linked with Centers for Medicare and Medicaid Services' outcomes of death and hospitalization through Dec. 31, 2017.

In patients with HF, the authors found that practice-level performance across quartiles was associated with a lower risk of death or hospitalization (compared with first quartile, second quartile hazard ratio [HR], 0.95, 95% CI, 0.83-1.09; third quartile HR, 0.86, 95% CI, 0.75-0.99; fourth quartile HR, 0.87, 95% CI, 0.76-1.01, p for trend = 0.0041). The same was observed for death alone (compared with first quartile, second quartile HR, 0.86, 95% CI, 0.74-0.99; third quartile HR, 0.78, 95% CI, 0.67-0.91; fourth quartile HR, 0.80, 95% CI, 0.68-0.94, p for trend <0.0001).

Hess and colleagues also note similar associations with individual HF measures of beta-blocker and ACE inhibitor/ARB use. Beta-blocker therapy in patients with CAD was also associated with a reduced risk of death (compared with first quartile, second quartile HR, 0.97, 95% CI, 0.85-1.10; third quartile HR, 0.87, 95% CI, 0.77-0.99; fourth quartile HR, 0.86, 95% CI, 0.75-0.98, p for trend = 0.0413).

No associations in practice-level composite measure performance and death or rehospitalization were seen in patients with AFib, coronary disease or hypertension.

"Clinical trials demonstrated that renin-angiotensin system inhibition as well as beta-blocker use increase survival and reduce hospitalization among patients with HF with reduced ejection fraction. Data predating the current reperfusion era similarly support the use of beta-blockers among patients with a history of myocardial infarction or reduced ejection fraction..." write the authors. "The current analysis suggests achievement in these aspects of guideline-concordant ambulatory cardiovascular care on a practice level translates to substantial clinical benefits in the real world."