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Performance Measures and Outcomes for Patients Hospitalized With Heart Failure—Reply
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In Reply: Drs Shishehbor and Litaker agree that additional process-of-care measures are needed but raise the issue that current measures do not adjust for patient adherence to prescribed evidence-based therapies. We agree that a care process requires at least some degree of patient adherence in order to influence postdischarge clinical outcomes, and differences in adherence rates are in part responsible for observed disparities between the magnitude of benefit observed in clinical trials (efficacy) and that observed in actual clinical practice (effectiveness).1
However, a bias toward lower patient adherence in our data may actually lessen the effect of appropriate application of evidence-based therapies, so that the improved outcomes associated with the use of ACE inhibitors or ARBs and  -blockers might be greater than we observed. We do concur that developing and validating process-of-care measures that factor in case mix might also enhance quality assessment.
Dr Radford and colleagues state that the . . . [Full Text of this Article]
Gregg C. Fonarow, MD
gfonarow@mednet.ucla.edu
University of California Los Angeles Medical Center
Los Angeles
Clyde W. Yancy, MD
Baylor University Medical Center
Dallas, Tex
William T. Abraham, MD
Ohio State University
Columbus
Barry H. Greenberg, MD
University of California San Diego Medical Center–Hillcrest
San Diego
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Performance Measures and Outcomes for Patients Hospitalized With Heart Failure
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JAMA. 2007;297(14):1547.
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Performance Measures and Outcomes for Patients Hospitalized With Heart Failure
Martha J. Radford, Robert O. Bonow, Raymond J. Gibbons, and Steven E. Nissen
JAMA. 2007;297(14):1547-1548.
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