Program in Cardiovascular Quality and Outcomes

Despite major advances in diagnosis and treatment, cardiovascular disease remains the leading cause of death in the United States and worldwide. Over 900,000 individuals in the United States and 17 million throughout the world die from cardiovascular diseases each year. The aftermath of heart attacks, strokes, and heart failure rob millions of men and women of fruitful, productive years. These conditions also create a huge economic burden and represent the greatest drain on healthcare resources.  

Although basic research must continue in order to develop new therapies to prevent and treat cardiovascular diseases, we already have a number of the tools necessary to reduce their impact. Many treatments have been proven effective in multiple large scale clinical trials, and clinical guidelines specify how, when, and in whom these treatments should be provided. Despite guidelines, however, these treatments can be underused, overused, or misused.  The risk factors for cardiovascular disease are known but are often ignored, underappreciated, or untreated. There is compelling evidence of variations in the quality of care that is provided to patients with heart disease in the United States, even within the same city, as is the case in Chicago. There is a gap between knowledge and implementation, between what we know and what we do.

The system of cardiovascular care delivery needs to be scrutinized, studied, and redesigned.

The Center is actively engaged in the national discourse on healthcare quality. Drs. Bonow, Goldberger and Grady have leadership roles in a number of the organizations addressing cardiovascular healthcare quality at the national level, including the American College of Cardiology, the American Heart Association, the American Medical Association, the National Heart, Lung, and Blood Institute, the Agency for Healthcare Research and Quality, the National Quality Forum, the National Committee for Quality Assurance, and the Joint Commission.

At Northwestern, our initial focus is improving the quality of care for patients with heart failure, because of the significant impact of this condition on human lives and healthcare resources. As we become more adept at treating the acute phases of heart disease, such as heart attacks, the dividend we pay is the growing number of older patients surviving with chronically weakened hearts.  Heart failure represents the leading cause of hospitalization in patients over the age of 65. Following hospitalization, over 30% of patients will die or be re-hospitalized within the next 60 days. Much of these poor early outcomes hinge on inability to identify the patients at greatest risk and the precarious transition of care from the inpatient to the outpatient setting, which is ripe with potential errors in medications, communication,  and scheduling of outpatient care.

Dr. Gheorghiade provides expertise from decades of work in clinical trials of heart failure treatment, and he is leading efforts to identify predictors of mortality and hospitalization from large scale databases. Dr. Pang is assessing processes of care from the perspective of the emergency department, which is the entry point of hospitalization and re-hospitalization. Dr. Farmer is studying health policy implications of heart failure management. We are assessing the role of electronic medical records and dedicated nurse practitioners in improving heart failure outcomes. Partnering with the American Medical Association, we have used the Northwestern Electronic Data Warehouse (EDW), a unique resource linking inpatient and outpatient electronic medical records, to determine factors that identify patients during a heart failure hospitalization who are at highest risk of death or hospital readmission following discharge. We are also assessing factors that predispose to hospitalization from the patient’s and family’s point of view. This detailed analysis, which cannot be ascertained with large administrative databases, allows us to develop targeted interventions for patients at highest risk.