[The effects of implementation of heart failure guidelines in the Pordenone province: analysis of the results following databases of the regional health guide system].

BACKGROUND: The aim of this study was to evaluate the effects of heart failure guideline implementation in the Pordenone province area, by using the regional health system databases. METHODS: We created the provincial registry of hospitalization for heart failure and we defined a set of indicators to assess the adequate use of the hospital facility, the correct use of diagnostic instruments, the appropriate use of medications, the in-hospital, 6-month and 1-year mortality rates. RESULTS: Up to December 31, 2002, 2977 subjects, living in the Pordenone province area, were hospitalized for heart failure (10.4 for 1000 inhabitants). Repeated hospitalizations in the years have percentage values oscillating at around 20%. The average length of hospitalization appeared declining, ranging from 11.1 days in 2000 to 10.3 days in 2002. The in-hospital death rate varied between 16-17%. The cumulative death rate within 6 months (33.2%) and 1 year (41.0%) of hospitalization resulted rather high, also considering the patients' advanced mean age (79 years). The percentage of patients who underwent an echocardiogram as outpatients in the previous year increased from 5.7% in 2000 to 13.1% in 2002. As for therapy, an increase in the percentage of patients treated with ACE-inhibitors (from 44.6 to 50.2%), sartans (from 8.2 to 11.7%), beta-blockers (from 11.7 to 16.7%) and diuretics (from 66.4 to 68.5%) was evident from 2000 to 2001. A mild reduction in the percentage of patients treated with digitalis (from 35.0 to 33.8%) and with calcium antagonists (from 22.4 to 20.9%) was also noted. CONCLUSIONS: The results of this study show that it is possible to use some indicators in evaluating the effects of guideline implementation in heart failure, by using the regional health system data. The final goal is to gradually involve all the professionals in the different phases of the natural course of heart failure patients, particularly the general practitioners.