Spotlight: Partnered Research to Improve Heart Failure Care for Veterans

February 2014

Heart failure currently affects nearly five million Americans, and hospital admissions for this condition have increased six-fold in the United States since 1970, due, in part, to an aging population. Moreover, heart failure is the number one reason for discharge for Veterans treated within the VA healthcare system. Therefore, VA/HSR&D's Chronic Heart Failure Quality Enhancement Research Initiative (CHF-QUERI) works to improve the health and healthcare for Veterans with CHF. This QUERI Center's main goals include:

• Decreasing unnecessary hospitalizations, tests, and treatments for heart failure;
• Increasing the use of life-prolonging therapy; and
• Increasing the use of therapy that improves quality of life.

As part of these efforts, CHF-QUERI works to identify and implement improved treatment. There are several medications that have been shown to decrease patient symptoms, hospitalizations, and to improve survival for individuals with heart failure. For example, aldosterone antagonist therapy has been shown to decrease hospital readmission rates among older patients with heart failure and reduced ejection fraction¹; however, the use of aldosterone antagonists for Veterans with CHF being treated in the VA healthcare system was suboptimal. In order to improve the use of this therapy among Veterans, CHF-QUERI found a VA Operations partner that was already working toward this goal.

CHF-QUERI Partners with Pharmacy Benefits Management

VA's Pharmacy Benefits Management (PBM) Services recently developed guidelines that recommended aldosterone antagonist therapy for Veterans with heart failure. After consulting with CHF-QUERI, PBM worked toward using their existing network of pharmacists to increase the use aldosterone antagonist at each VA facility, following up with patients within one week. The goals of the joint CHF-QUERI and PBM project were to:

• Determine the extent to which monitoring was being done,
• Determine in which areas monitoring was deficient, and
• Identify where improvements were needed.

CHF-QUERI investigators conducted the study analysis and served as consultants throughout the project, providing an important research perspective for PBM, while CHF-QUERI investigators were able to see how the Operations side works; in particular, what things were important to PBM, such as timely feedback that could have an immediate impact on the healthcare of Veterans.

This project is expected to increase the recommended use of aldosterone antagonists, which, in turn, will improve mortality and decrease hospitalizations among Veterans with heart failure. Another beneficial outcome of this project will be a better understanding of how to use pharmacists in the VA network to improve patient care on a local level. By examining barriers and facilitators at different VA healthcare facilities, investigators will learn what works and what doesn't–and will know how best to spread those elements of the intervention that work well throughout the VA healthcare system.

For more information, please see the video titled "Research-Operations Partnerships: Improving Heart Failure Care" on the CHF-QUERI main web page. This video features, Paul Heidenreich, M.D., CHF-QUERI Director, and Elaine Furmaga, Pharm.D., National PBM Clinical Pharmacy Program Manager, who discuss this successful collaboration.

For general information about CHF-QUERI, please contactAnju Sahay, Ph.D., CHF-QUERI Implementation Research Coordinator, at Anju.Sahay@va.gov .

Reference

Hernandez A, Mi X, Hammill B, et al. Associations between aldosterone antagonist therapy and risks of mortality and readmission among patient with heart failure and reduced ejection fraction . JAMA 2012;308(20):2097-2107.

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