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2017 Updates to Target: Heart FailureJuly 20, 2017Presenter: Gregg C. Fonarow, MD, FACC, FAHA
Our PresenterGregg C. Fonarow, MD, FACC, FAHAThe Eliot Corday Professor of Cardiovascular Medicine and ScienceCo-Chief of Clinical Cardiology UCLA Division of CardiologyDirector, Ahmanson-UCLA Cardiomyopathy CenterCo-Director, UCLA Preventative Cardiology Program
Disclosures Research NIH Consultant Amgen Janssen Medtronic Novartis St. Jude Medical
Target:HF OverviewWhat Is Target: HF? Launched in 2011, A national initiative of the American HeartAssociation within GWTG HF that focuses on targeted area thatprovides healthcare professionals with content-rich resources andmaterials designed to help advance heart failure awareness,prevention, and treatment.Target: Heart Failure Mission:Increase 3 key patient-centered care domains with very well established oremerging evidence-base: Medication optimization Early follow-up and care coordination Enhanced patient education
Get With The Guidelines - Heart Failure Overview Get With The Guidelines - Heart Failure launched in 2005 4 Achievement Measures and 10 Quality Measures Hospitals enrolled have several opportunities to be recognized for theirefforts and are recognized at National events As of June 2017, there are greater than 87 Get With The Guidelinesmanuscripts focused on Heart Failure.– Publications are viewable at www.heart.org 684 Hospitals enrolled in the program Over 1,500,000 patients entered into the PMT
Most Comprehensive Measure Set AvailableAchievement Measures ACEI/ARBs or ARNi atDischarge*Evidence-Based Specific BetaBlockers*Measure LV FunctionPost-Discharge Appointment forHeart Failure PatientsQuality Measures ARNi at DischargeAldosterone Antagonist atDischarge*Anticoagulation for AtrialFibrillation and Atrial FlutterHydralazine Nitrate at DischargeDVT ProphylaxisCRT-D or CRT-P Placed orPrescribed at DischargeICD Counseling Provided orPrescribed or Placed at DischargeInfluenza Vaccination During FluSeasonPneumococcal VaccinationFollow-Up Visit Scheduled Within 7Days or LessReporting Measures Blood Pressure Control atDischargeBeta Blocker at DischargeBeta Blocker Medication atDischargeLipid-Lowering Medications atDischargeOmega-3 Fatty Acid SupplementUse at DischargeDiabetes TreatmentDiabetes TeachingSmoking CessationDischarge InstructionsICD Placed or Prescribed atDischargeAdvanced Care PlanQRS Duration DocumentedHeart Failure DiseaseManagement Program ReferralFollow-Up Visit or Contact Within48 Hours of Discharge Scheduled
Most Comprehensive Measure Set AvailableReporting Measures (Continued) Descriptive Measures Follow Up Visit or ContactWithin 72 Hours of DischargeScheduled60 Minutes of Heart FailureEducationReferral to AHA Heart FailureInteractive WorkbookReferral to HF DiseaseManagement, 60 MinutesPatient Education, Or HFInteractive Workbook*Heart Failure Activity LevelHeart Failure DietHeart Failure Follow-UpHeart Failure WeightHeart Failure SymptomsWorsenLength of StayCare Transition RecordTransmittedAdvance Directive ExecutedDischarge DispositionIvabradine Prescribed AgeDiagnosisGenderRaceHF Composite MeasureHF Defect-Free MeasureJC/CMS HF Defect FreeMeasureTarget: HF Defect FreeMeasureMortality & ReadmissionMeasures In-Hospital Mortality Risk Adjusted Mortality Ratio Readmission Frequency & Rate 30, 60 & 90 Day Readmissions &Rate Not equivalent to the CMS30-Day Risk-StandardizedReadmission Measure. It isnot risk-adjusted, does notrepresent all causereadmission, and does notcapture readmissions fromother hospitals.
Target: HF Award Recognition Measures Discharge use of ACEI/ARB or ARNi Evidence-based beta blocker Aldosterone antagonist (In all eligible heart failure patients with reduced LVEF,in absence of documented contraindications, intolerance, or patient/systemreasons) Early post-discharge follow-up with visit or phone call scheduled to occurwithin 7 days of hospital discharge UPDATED: Enhanced patient education as evidenced by referral to heartfailure disease management program, provision of at least 60 minutes of heartfailure education by a qualified heart failure educator, or provision of AHA heartfailure interactive workbook OR were referred to an outpatient cardiacrehabilitation programUpdated recognition measure available in the PMT Spring 2018
Target: Heart Failure Honor Roll RecognitionRequirements: Documentation of all three carecomponents for 50% or greater of compliance for eligiblepatients with heart failure.Hospitals must be GWTG-HF performance achievementaward hospitals.
Target:HF Honor Roll2011 to 2017201220132014201520162017130438 Total Awardsto date111192 Hospitals Awardedto date80654111Target:HF Honor Roll
GWTG-HF: Achievement Measures (1)100%90%80%70%60%50%40%30%20%10%0%Evidence Based BB for LVSD @ D/C2005200620072008Measure LV Function20092010201120122013201420152016April 2017
GWTG-HF: Achievement Measures 08ACEI/ARB or ARNI at D/C20092010201120122013201420152016Post Discharge ApptApril 2017
GWTG-HF: Achievement Measures (3)100%90%80%70%60%50%40%30%20%10%0%Composite Performance Measure2005200620072008100% Compliance Measure20092010201120122013201420152016April 2017
GWTG-HF: Quality Measures (1)100%90%80%70%60%50%40%30%20%10%0%Aldosterone Antagonist at D/C for LVSD2005200620072008Anticoagulation for AF20092010201120122013201420152016April 2017
GWTG-HF: Quality Measures (2)100%90%80%70%60%50%40%30%20%10%0%Hydralazine at D/C for AA2005200620072008ICD placed or prescribed at D/C20092010201120122013201420152016April 2017
GWTG-HF: Quality Measures (3)100%90%80%70%60%50%40%30%20%10%0%DVT ProphylaxisCRT-D or CRT-P Placed or Prescribed atD/C2009201020112012201320142015Influenza Vaccination During Flu Season2016April 2017
GWTG-HF: Quality Measures (4)100%90%80%70%60%50%40%30%20%10%0%Pnumococcal Vaccination20092010Follow-up Visit Within 7 Days201120122013201420152016April 2017
Program Updates
Objectives of the Update Re-brand Get With The Guidelines Target: Heart Failure Enhance clinical tools to be reflective of the 2013 HF Guidelines, andupdates in 2016 and 2017 Launch OnTarget, a monthly newsletter featuring clinical resources andon key program elements Update the main website heart.org/targethf with updated branding Launch the Target:HF App to bring key clinical resources to your mobiledevice
Taking Action National Heart Failure Clinical Work Group members met toreview and assess the program Conducted a review of all existing materials and providedupdates to the clinical tools Materials were updated and went through a thorough AHAscience review Updates made are reflective of the 2013 ACCF/AHA Guideline forthe Management of Heart Failure and the updates released in2016 and 2017
Taking Action Enhancements to clinical tools include: Medication updates including ARNi and Ivabradine Inclusion of the LACE risk score as an additional clinical tool Updated Target:HF Composite measure to include CardiacRehab Updated patient readmission risk factor, medicationadherence and cardiac rehab Updated list of factors of readmission to include patientfactors such as: frailty, cognition/memory, social support andlanguage barriers, etc.
Update to Target:HF Composite Measure
Taking ActionUpdated Collateral
Identifying Avenues for Growth Conducted in-depth telephone interviews with active Target: HF customers A qualitative discussion guide was used focusing on: Challenges associated with caring for heart failure patientsTarget HF program awareness and benefitsHF resources currently usedWebsite feedbackCommunication preferences Assessed hospital needs for resources to support their efforts to treat heartfailure and lower readmission rates. Determined availability of resources for hospitals, and identify how Target: HFfills the gap. Assessed current program look and feel, programmatic, marketing, andcommunications elements
Identifying Avenues for GrowthTarget: HF Customer Survey - Insight on Metrics General consensus is the right metrics are in place, and that they arehelpful in keeping the focus on the patient (rather than hospital process) Most frequently discussed metrics were evidence-based beta blockers,in-hospital education, and scheduling follow-up appointments Those within the Quality area spoke to the need for more powerful datamining software to allow for more detailed/customized extractions andaggregations Ability for EHR information to automatically flow into Get With TheGuidelines so less time is spent on chart extractions
Connecting with a Wider AudienceOn Target Newsletter Series Emailed monthly Highlights key-topics in improving 30-dayrehospitalization rates Special 3 month focus on medicationadherence including: ACE/ARB or ARNI,Evidence-based beta blockers, AldosteroneAntagonist Featured Clinical Tools and ResourcesTo receive OnTarget, email, liz.olson@heart.org
Website Updates Heart.org/targethf New look launching in the comingmonth Refreshed look and feel. Revised navigation Easier to access key programmaterials, research and patienteducation resources
INTRODUCING! Target: HF App Progressive Web App Interactive mobile site – designed for mobile use Dedicated link targethf.heart.org (COMING SOON) Ability to save to home screen Adaptability for phone, tablet users Accessible from computer Includes the Yale Risk Calculator and LACE Calculator; input data right from your phone, tablet Key clinical topics in heart failure featured in ourmedia area Editable PDF clinical tools Clinical Tools editable in-app with CSV email
Target: HF AppHome Screen and Menu
Target: HF AppClinical Tools All clinical tools updated with the latestscience. Fast, easy access to our most valuableclinical Tools Documents available in English andSpanish New resources for patient education incardiac rehab, medication adherenceand more Links to Rise Above HF initiative Updated Interactive Workbook “MY HFGUIDE” accessible from the app onyour phone or tablet
Target: HF AppWebinar Recordings Featuring important topics in themanagement of Heart Failure Archive of past national AHA GWTGHF and Target:HF webinars Viewable in app on your mobile phoneor tablet Future updates will include bonusvideo and audio content not availableon heart.org
Target: HF AppLACE Calculator
Special thanks to our Target:HF sponsorNovartis PharmaceuticalsNovartis Pharmaceuticals Corporation is a national sponsor ofAmerican Heart Association's Target: Heart Failure.
Contact Us to Learn MoreSteve Dentel BSN, RN, CPHQNational Director, Field Programs and Integrationsteve.dentel@heart.orgGWTG-Heart FailureTanya Lane Truitt, RN MSSr. Program Manager Quality Systems Improvementtanya.truitt@heart.orgLiz OlsonProgram Manager, Get With The Guidelines – Heart Failureliz.olson@heart.orgStay informed on the latest updates from Get With The GuidelinesSign Up for Focus on Quality e-Communications
THANK YOUfor your active participation andcontributions to GWTG-HF
JC/CMS HF Defect Free Measure Target: HF Defect Free Measure. Mortality & Readmission Measures In-Hospital Mortality Risk Adjusted Mortality Ratio Readmission Frequency & Rate 30, 60 & 90 Day Readmissions & Rate Not equivalent to the CMS 30-Day Risk-Standardized Readmission Measure. It is not risk-adjusted, does not
