Quality Indicators for the Management of Heart Failure in Vulnerable Elders

• Quality indicators, health care
• Aged
• Heart failure, congestive
• Outcome and process assessment (health care)
• Angiotensin-converting enzyme inhibitors

Heart failure is a common medical condition that contributes to substantial morbidity and mortality in elderly persons and greatly affects public health. In the United States, an estimated 4.6 million persons have heart failure, and 400 000 to 700 000 new cases develop each year (1). The prevalence of heart failure increases with age: It is present in 2% of persons 40 to 59 years of age, more than 5% of persons 60 to 69 years of age, and 10% of persons 70 years of age or older. As the U.S. population ages, the incidence and prevalence of this disease are expected to increase markedly. Heart failure is the primary diagnosis for 875 000 hospitalizations annually, and it is the most common diagnosis among hospitalized patients 65 years of age or older. Heart failure is a proximate or secondary cause of death in approximately 250 000 people per year. The overall fatality rate is high: Twenty percent of patients die within the first year after diagnosis, and 50% die within 5 years (1). In 1998, the estimated annual direct cost of heart failure was $18.8 billion.

Improving quality of care for heart failure may substantially decrease morbidity and mortality. This review investigates the relationship between processes and outcomes of care and identifies quality indicators that may be applied in evaluating vulnerable elders with heart failure.