Congestive heart failure - which has no known cure - causes the heart to gradually lose its ability to pump blood. More than 4,000 cases of congestive heart failure (CHF) are treated within the Sutter Health network each year. CHF represents 17,450 hospital bed days and has a readmit rate of nearly 16 percent.

Congestive Heart Failure (CHF) affects a growing number of people each year as more people survive heart attacks, and are left with residual heart problems.

• Sutter Health's Congestive Heart Failure Project
• Clinical Guidelines Adopted
• Patient Education
• Cardiovascular Database

Sutter Health's Congestive Heart Failure Project

For the CHF project, the team undertook a massive outreach education effort that included adoption of common guidelines, measurements and patient materials at all levels of our network. The goal of Sutter Health's project is to promote consistent management of CHF and better outcomes for CHF patients by:

• prevent unnecessary emergency room visits and hospital admissions
• promote consistency in use of ace inhibitors-new medicines that improve cardiac output
• promote better self-management through patient education and lifestyle changes

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Clinical Guidelines Adopted

At the onset of Sutter Health's CHF project, a 13-member expert panel of 10 physicians, two registered nurses and a health administrator conducted a literature search to identify the best methods of care for CHF patients. Five cardiologists were included on the panel.

The team decided that the guidelines by the Institute for Clinical Systems Integration were really good and they couldn't improve upon them. Developed by the Mayo Clinic and HealthSystem Minnesota, the Institute for Clinical Systems Integration CHF guidelines were endorsed by Sutter Health's Clinical Leadership Council.

A few things make a significant difference for CHF patients. These include:

• ACE inhibitors, which have been found to reduce morbidity and mortality.
• Quick administration of intravenous diuretics in the appropriate dosage for emergency room patients.
• Patient education, which improves compliance with treatment plans and increases quality of life for CHF patients.

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Patient Education

One of the goals of our CHF project is to promote better self-management through patient education and lifestyle changes.

Smoking is one of "the most important health risks in this country." In 2002, Sutter Health implemented standard smoking cessasion materials across all of our affiliates.
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Cardiovascular Database

For the past two years, a group of clinical and IT experts from across the Sutter Health system have worked together to analyze the need for a standardized data repository for cardiovascular surgery and cath lab services, and then determine how to meet that need. In 2002, the group came to consensus on the purchase and implementation of the Apollo Cardiovascular Information System (CVIS) by Lumedx as the Sutter Health system standard.

Working within a three-year implementation timeframe, Sutter Health affiliates will eventually be able to submit standardized data to the national registries of both the Society of Thoracic Surgeons (STS) and the American College of Cardiology (ACC). We will also be poised to report cardiac surgery outcomes to the State of California's CABG Outcomes Reporting program (CCORP).

In addition to participating in national benchmarking and state-mandated reporting, Sutter Health will now have a rich internal database for comparing best clinical practice and creating better, safer care for our cardiac surgery and cardiology patients.
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