Use and predictors of heart failure disease management referral in patients hospitalized with heart failure: Insights from the get with the guidelines program

Background: Heart failure disease management (HFDM) may be beneficial in heart failure (HF) patients at risk for readmission or post-discharge mortality. However, characteristics of hospitalized HF patients referred to HFDM are not known. Methods and Results: Get With the Guidelines (GWTG) program data was used to analyze 57,969 patients hospitalized with HF from January 2005 through January 2010 from 235 sites. Factors associated with referral to HFDM and rates of HF quality measures by referral status were studied. Mean age of patients was 69.7 ± 14.5 years, 52% were men, and 65% were white. HFDM referral occurred in 11,150 (19.2%) patients. The median rate of HFDM referral among all hospitals was 3.5% (25th-75th percentiles 0%-16.7%) and 8.7% (2.8%-27.7%) among hospitals with at least one previous HFDM referral. Quality and performance measures were higher in patients referred to HFDM. HFDM referral was associated with atrial fibrillation, implanted cardiac device, depression, and treatment at larger hospitals. Patients at higher 90-day mortality risk were paradoxically less likely to receive HFDM referral. Conclusions: HFDM referral occurred in less than one-fifth of hospitalized HF patients and was more frequently recommended to lower-risk patients. Increasing use and optimizing selection of patients for HFDM referral is a potential target for quality improvement.