Quality of care for heart failure patients hospitalized for any cause.
J Am Coll Cardiol. 2013 Sep 25;
Authors: Blecker S, Agarwal SK, Chang PP, Rosamond WD, Casey DE, Kucharska-Newton A, Radford MJ, Coresh J, Katz S
Abstract
OBJECTIVE: To assess the quality of care for heart failure patients who are hospitalized for all causes.
BACKGROUND: Performance measures for heart failure target patients with a principal diagnosis of heart failure. However, patients with heart failure are commonly hospitalized for other causes and may benefit from treatments such as angiotensin converting enzyme (ACE) inhibitors for left ventricular (LV) systolic dysfunction.
METHODS: We assessed rates of compliance with care measures for patients hospitalized with acute or chronic heart failure in the Atherosclerosis Risk in Communities (ARIC) surveillance catchment area from 2005-2009. Rates of compliance were compared between patients with a principal discharge diagnosis of heart failure and those with another principal discharge diagnosis.
RESULTS: Of 4,345 hospitalizations of heart failure patients, 39.6% carried a principal diagnosis of heart failure. Patients with a principal heart failure diagnosis had higher rates of LV function assessment (89.1% versus 82.5%; adjusted prevalence ratio (aPR) 1.07, 95% CI 1.04-1.10) and discharge ACE inhibitor/ARB in LV dysfunction (64.1% versus 56.3%; aPR 1.11, 95% CI 1.03-1.20) as compared to patients hospitalized for another cause. LV assessment and ACE inhibitor/ARB use were associated with reductions in one year post-discharge mortality (adjusted odds ratios 0.66, 95% CI 0.51-0.85 and 0.72, 95% CI 0.54-0.96, respectively) that did not differ for patients with versus without a principal heart failure diagnosis.
CONCLUSIONS: Compared to individuals hospitalized with a principal diagnosis of heart failure, heart failure patients hospitalized for other causes were less likely to receive guideline recommended care. Quality initiatives may improve care by targeting hospitalizations with either principal or secondary heart failure diagnoses.
PMID: 24076281 [PubMed - as supplied by publisher]