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BOSTON -- Much progress has been made in managing heart failure, but there are still some areas of controversy that will be highlighted at the upcoming meeting of the Heart Failure Society of America here.

"We've been remarkably successful in heart failure in making headway with therapies to help stabilize this disease, to turn it from a death sentence into a chronic disease with which many people can have good quality of life for extended periods of time," said Lynne Warner Stevenson, MD, director of the cardiomyopathy and heart failure program at Brigham and Women's Hospital in Boston.

"At the same time, that's brought us to a level where there's a lot of controversy over where to go next and what to do to build on what we've done," said Stevenson, who is co-chair of the scientific program committee for this year's meeting.

One of the most important issues that will be tackled at the meeting is how to measure the quality of care delivered to patients with heart failure by individual providers, hospitals, and health systems, Stevenson said.

There are two schools of thought on the subject, both of which recognize that substantial progress has been made in accumulating evidence, crafting practice guidelines, and spreading the information into the community.

"We all agree on the progress of these steps," she said.

But the two schools diverge when it comes to measuring performance of evidence-based therapies. One believes that a scorecard should be used to assess the quality of care, measuring factors such as the number of patients on certain therapies, the hospital readmission rate for heart failure, and the clinic mortality rate.

"And then there's the opposing school of thought, which is that some of these measures may in fact take us to the wrong place," Stevenson explained, pointing out that a scorecard implies that there is a high degree of certainty about what every patient should be doing.

But opponents to a scorecard approach feel that it is not always known what will work for an individual patient, especially considering that scientific advances often move faster than the guideline-writing process, Stevenson said.

"In light of new knowledge, we don't want physicians -- or most importantly, their patients -- to be pressured into conformity with therapies for which risks may turn out to override the benefit," she said, paraphrasing Jalal Ghali, MD, of Harper University Hospital in Detroit, who will be making a presentation at the meeting. Guideline-based care may not be applicable to patients with multiple conditions, for instance.

Stevenson said there is a tension between standardized care and individualized care in the current climate, which is "probably healthy."

"Trying to find the right balance of those two is of critical importance for patients, for national policy, etc.," she said, "and I think we've tried to highlight that controversy so people on each side are aware of the importance of finding the right middle ground."

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