RT Journal Article SR Electronic T1 Hospital-based quality improvement interventions for patients with heart failure: a systematic review JF Heart JO Heart FD BMJ Publishing Group Ltd and British Cardiovascular Society SP 431 OP 438 DO 10.1136/heartjnl-2018-314129 VO 105 IS 6 A1 Agarwal, Anubha A1 Bahiru, Ehete A1 Yoo, Sang Gune Kyle A1 Berendsen, Mark A A1 Harikrishnan, Sivadasanpillai A1 Hernandez, Adrian F A1 Prabhakaran, Dorairaj A1 Huffman, Mark D YR 2019 UL http://heart.bmj.com/content/105/6/431.abstract AB Objective To estimate the direction and magnitude of effect and quality of evidence for hospital-based heart failure (HF) quality improvement interventions on process of care measures and clinical outcomes among patients with acute HF.Review methods We performed a structured search to identify relevant randomised trials evaluating the effect of in-hospital quality improvement interventions for patients hospitalised with HF through February 2017. Studies were independently reviewed in duplicate for key characteristics, outcomes were summarised and a qualitative synthesis was performed due to substantial heterogeneity.Results From 3615 records, 14 randomised controlled trials were identified for inclusion with multifaceted interventions. There was a trend towards higher in-hospital use of ACE inhibitors (ACE-I; 57.9%vs40.0%) and beta-blockers (BBs; 46.7%vs10.2%) in the intervention than the comparator in one trial (n=429 participants). Five trials (n=78 727 participants) demonstrated no effect of the intervention on use of ACE-I or angiotensin receptor blocker at discharge. Three trials (n=89 660 participants) reported no effect on use of BB at discharge. Two trials (n=419 participants) demonstrated a trend towards lower hospital readmission up to 90 days after discharge. There was no consistent effect of the quality improvement intervention on 30-day all-cause mortality, hospital length of stay and patient-level health-related quality of life.Conclusions Randomised trials of hospital-based HF quality improvement interventions do not show a consistent effect on most process of care measures and clinical outcomes. The overall quality of evidence for the prespecified primary and key secondary outcomes was very low to moderate, suggesting that future research will likely influence these estimates.Trial registration number CRD42016049545.