# Ziekenhuis- en post-ontslagkwaliteitsinterventie bij HF: JAMA CONNECT-HF

*geplaatst 2021-07-27 · Hartfalen · JAMA · doi 10.1001/jama.2021.8844 · https://hartvaat.nl/2021/07/27/ziekenhuis-en-post-ontslagkwaliteitsinterventie-bij-hf-jama-connect-hf/*

JAMA CONNECT-HF trial naar het effect van een kwaliteitsverbeteringsinterventie op uitkomsten en kwaliteit bij hartfalen.

## English: Effect of a Hospital and Postdischarge Quality Improvement Intervention on Clinical Outcomes and Quality of Care for Patients With Heart Failure With Reduced Ejection Fraction: The CONNECT-HF Randomized Clinical Trial.

The CONNECT-HF trial showed that a hospital and post-discharge quality improvement intervention did not significantly reduce mortality or heart failure rehospitalization, highlighting the challenges of translating guideline adherence into outcome improvement.

## Abstract (original, from the publication)

IMPORTANCE: Adoption of guideline-directed medical therapy for patients with heart failure is variable. Interventions to improve guideline-directed medical therapy have failed to consistently achieve target metrics, and limited data exist to inform efforts to improve heart failure quality of care. OBJECTIVE: To evaluate the effect of a hospital and postdischarge quality improvement intervention compared with usual care on heart failure outcomes and care. DESIGN, SETTING, AND PARTICIPANTS: This cluster randomized clinical trial was conducted at 161 US hospitals and included 5647 patients (2675 intervention vs 2972 usual care) followed up after a hospital discharge for acute heart failure with reduced ejection fraction (HFrEF). The trial was performed from 2017 to 2020, and the date of final follow-up was August 31, 2020. INTERVENTIONS: Hospitals (n = 82) randomized to a hospital and postdischarge quality improvement intervention received regular education of clinicians by a trained group of heart failure and quality improvement experts and audit and feedback on heart failure process measures (eg, use of guideline-directed medical therapy for HFrEF) and outcomes. Hospitals (n = 79) randomized to usual care received access to a generalized heart failure education website. MAIN OUTCOMES AND MEASURES: The coprimary outcomes were a composite of first heart failure rehospitalization or all-cause mortality and change in an opportunity-based composite score for heart failure quality (percentage of recommendations followed). RESULTS: Among 5647 patients (mean age, 63 years; 33% women; 38% Black; 87% chronic heart failure; 49% recent heart failure hospitalization), vital status was known for 5636 (99.8%). Heart failure rehospitalization or all-cause mortality occurred in 38.6% in the intervention group vs 39.2% in usual care (adjusted hazard ratio, 0.92 [95% CI, 0.81 to 1.05). The baseline quality-of-care score was 42.1% vs 45.5%, respectively, and the change from baseline to follow-up was 2.3% vs -1.0% (difference, 3.3% [95% CI, -0.8% to 7.3%]), with no significant difference between the 2 groups in the odds of achieving a higher composite quality score at last follow-up (adjusted odds ratio, 1.06 [95% CI, 0.93 to 1.21]). CONCLUSIONS AND RELEVANCE: Among patients with HFrEF in hospitals randomized to a hospital and postdischarge quality improvement intervention vs usual care, there was no significant difference in time to first heart failure rehospitalization or death, or in change in a composite heart failure quality-of-care score. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03035474.

Auteurs: Adam D DeVore, Bradi B Granger, Gregg C Fonarow, Hussein R Al-Khalidi, Nancy M Albert, Eldrin F Lewis, Javed Butler, Ileana L Piña, Larry A Allen, Clyde W Yancy, Lauren B Cooper, G Michael Felker, Lisa A Kaltenbach, A Thomas McRae, David E Lanfear, Robert W Harrison, Maghee Disch, Dan Ariely, Julie M Miller, Christopher B Granger, Adrian F Hernandez

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Bron: JAMA, https://doi.org/10.1001/jama.2021.8844. Bijgewerkt 2026-07-03T13:28:26Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.