Guidelines Are Crucial for Treating Heart Failure in Hospitals

Hospitals with low patient volume are less likely to adhere to heart failure (HF) process measures compared with high-volume hospitals, according to a recent study.

For their study, the researchers assessed data on 125,595 patients who were enrolled in the Get With The Guidelines- HF registry, as well as Medicare inpatient data from 342 hospitals.
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Hospitals were categorized into 4 quartiles based on patient volume, which was assessed as a continuous variable. Process measures at discharge that were examined included achievement of HF measures, quality, reporting, and composite metrics.

Findings from multivariable modeling revealed that low-volume hospitals were much less likely to adhere to HF process measures vs high-volume hospitals. However, patients admitted to high-volume hospitals tended to have more comorbidities vs patients admitted to low-volume ones.

The researchers noted that there was no association of higher hospital volume with a difference in in-hospital mortality, 30-day mortality, or 30-day readmissions. They observed a weak association of higher hospital volume with lower rates of 6-month mortality and 6-month all-cause readmissions.

“Our analysis of a large contemporary prospective national quality improvement registry of older patients with HF indicates that hospital volume as a structural metric correlates with process measures, but not with 30-day outcomes, and only marginally with outcomes up to 6 months of follow-up,” the researchers concluded.

“Hospital profiling should focus on participation in systems of care, adherence to process metrics, and risk standardized outcomes rather than on hospital volume itself.”

—Christina Vogt

Reference:

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. https://doi.org/10.1161/CIRCULATIONAHA.117.028077.