OBJECTIVES: Compliance with heart failure treatment guidelines may improve quality of care and reduce healthcare utilization and costs. For accreditation purposes, hospitals are required by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) to measure performance for treatment of patients with heart failure. The purpose of this study is to determine the effect of hospital compliance with JCAHO performance measures and published guidelines on outcomes of patients with heart failure (HF). METHODS: Thirty hospitals submitted data on 1340 patients admitted with HF between January 2, 2002 and March 30, 2002. The data included patient demographics, HF severity, co-existing illnesses, and type of medication therapy during hospitalization and at discharge. Univariate and multivariate analyses such as ordinary least square (OLS) regression, logistic regression, and Cox regression analyses were applied. RESULTS: Current tobacco use and co-existing illnesses such as cardiomyopathy and chronic renal disease were significantly associated with longer hospital length of stay (LOS). Moreover, patients admitted to community hospitals had a lower inpatient mortality rate. Patients receiving discharge instructions regarding follow-up appointment and weight monitoring had significantly lower hospital LOS and mortality. Overall, patients receiving treatment according to published guidelines had lower hospital LOS and inpatient mortality rate. However, receiving treatment in hospitals with a care plan for HF had no significant impact on LOS or mortality. CONCLUSIONS: Hospital compliance with JCAHO performance measures and published guidelines is associated with a significant reduction in patient LOS or inpatient mortality. However, patients treated in hospitals with a care plan for heart failure had no significant change in LOS or mortality.