Heart Failure Guideline Adherence in Hospitals
Patients with heart failure admitted to high-volume hospitals had a higher burden of comorbidities.
HealthDay News — Hospital adherence to heart failure guidelines might be the best quality measure, according to a study published in Circulation.
Dharam J. Kumbhani, MD, from the University of Texas Southwestern Medical Center in Dallas, and colleagues evaluated the relationship between admission volume, process-of-care metrics, and short- and long-term outcomes in 125,595 patients admitted with acute heart failure and participating in the Get With The Guidelines-Heart Failure registry at 342 hospitals.
The researchers found that patients admitted to high-volume hospitals had a higher burden of comorbidities.
After multivariable modeling, lower-volume hospitals were significantly less likely to be adherent to heart failure process measures vs higher-volume hospitals. However, higher hospital volume was not associated with a difference in in-hospital mortality, 30-day mortality, or 30-day readmissions. For longer-term outcomes, there was a weak association of higher volumes with lower six-month mortality (hazard ratio, 0.98; 95% CI, 0.97 to 0.99; P = .001) and lower 6-month all-cause readmissions (hazard ratio, 0.98; 95% CI, 0.97 to 1; P = .025).
"Hospital profiling should focus on participation in systems of care, adherence to process metrics, and risk-standardized outcomes rather than on hospital volume itself," the authors wrote.
Disclosures: Several authors disclosed financial ties to pharmaceutical and medical device companies, including companies that have provided funding for the Get With The Guidelines-Heart Failure program.
Kumbhani DJ, Fonarow GC, Heidenreich PA, et al. Association between hospital volume, processes of care, and outcomes in patients admitted with heart failure: insights from get with the guidelines-heart failure [published online January 29, 2018]. Circulation. doi:10.1161/CIRCULATIONAHA.117.028077.