Calidad del manejo de pacientes con insuficiencia cardiaca en el Servicio de Medicina Interna

Objective: To evaluate the quality management of Heart failure within an Internal Medicine Department, based in quality criteria settled in ACOVE study. Methods: Retrospective study reporting 267 patients admitted to ourInternal Medicine Department with a diagnosis of heart failure (from January 2001 to January 2001). We applied ACOVE protocol to evaluate quality of management assigning a positive numerical score to every accomplished section and a negative score to those sections that were not carried out. Results: Two hundred and sixty seven patients and their clinical records were evaluated (Mean age 76 ′ 9 years, male 50%). They had a mean score of 6.72 ′ 1.33 points. Heart failure etiology was determined in 82% (33% ischemic heart failure, 30% hypertensive heart disease, 12% valvulopathy and 7% others). ACE-Inhibitors/ARA II were used in 66% of patients, with poor utilization of beta-blockers (16%), calcium channel blockers (7%) and class I antiarrhythmic drugs (1%). 94% of patients had written instructions about manage of their disease. Only 36% of patients had an echocardiography study. In patients with atrial fibrillation, 19% were treated with oral anticoagulants and 26% with anti-platelet drugs. Inhospital mortality rate was 4%. We could not meet differences among different physicians and their gender in department of Internal Medicine treating for heart failure, however the score of patients older 70 years was 6.5 ′ 1.38 points while score in younger to years was 7.15 ′ 1.17 points (p = 0.011). Conclusions: Management of heart failure in our department of Internal Medicine is acceptable. However, there are several points in which improvement could be reached, much as to increase the utilization of ACE inhibitors and beta-blockers in handling of heart failure and to rise the are of echocardiography in the evaluation of these patiens. Moreover, older patients showed a lower quality level that could be improved.