Association between process performance measures and 1-year mortality among patients with incident heart failure: a Danish nationwide study

Nakano, Anne; Vinter, Nicklas; Egstrup, Kenneth; Svendsen, Marie Louise; Schjødt, Inge

doi:10.1093/ehjqcco/qcy041

Cited by 16 publications

(24 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Improvements in prognosis over years among Danish HF patients have been reported previously . However, changes in other factors apart from pharmacological treatment may have influenced the prognosis, including changes in the risk profile of the patients and improved non‐pharmacological treatment …”

Section: Discussionmentioning

confidence: 72%

Twenty‐year time trends in use of evidence‐based heart failure drug therapy in Denmark

Vinter

Jensen

Skjøth

et al. 2020

Basic Clin Pharma Tox

Self Cite

View full text Add to dashboard Cite

European guidelines for heart failure (HF) have continuously incorporated new evidence since the first publication in 1995. We aimed to explore time trends in utilisation of pharmacological treatment for HF and dispensing of recommended dosages among patients with a first‐time diagnosis of HF. We performed a historical cohort study of patients with a first‐time HF diagnosis from 1997 to 2015, identified in the Danish National Patient Registry. Dispensed pharmacological treatment included angiotensin‐converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), beta‐blockers, mineralocorticoid receptor blockers (MRAs), digoxin and diuretics. Furthermore, we estimated the proportion of patients receiving the recommended target dosages 1 year after the diagnosis. The utilisation increased and correlated with publication of landmark studies, and among patients diagnosed in 2015, approximately two of three received ACEI/ARB and beta‐blocker, respectively. Less than half of the patients redeeming prescriptions for ACEIs, ARBs, beta‐blockers or MRAs received the recommended target dosages. The utilisation of pharmacological therapy for HF appears to be correlated with the publications of landmark Phase III clinical trials. However, a high proportion of patients do not receive the recommended target dosages. Despite improvements over time, a substantial gap appears to remain between guideline recommendations and pharmacological therapy in routine care.

show abstract

Section: Discussionmentioning

confidence: 72%

Twenty‐year time trends in use of evidence‐based heart failure drug therapy in Denmark

Vinter

Jensen

Skjøth

et al. 2020

Basic Clin Pharma Tox

Self Cite

View full text Add to dashboard Cite

show abstract

“…14,20 For example, in a Danish nationwide study, researchers used echocardiography, New York Heart Association classification, treatment with ACEI/ARB, β-blockers, physical training and patient education to construct a composite process performance measure to represent overall quality of HF care, and found the association between performance measures and 1-year mortality that followed a doseresponse pattern. 20 In our study, 90 day and 1 year mortality rates of 10.8% and 21.0%, respectively, were observed in patients hospitalized in secondary hospitals, almost twice the corresponding rates of people hospitalized in tertiary institutions (90 day mortality: 5.0%; 1 year mortality: 12.1%). After controlling individual-level confounders, patients admitted to tertiary hospitals had a 51% lower risk of 90 day death and a 39% lower risk of 1 year mortality death.…”

Section: Discussionmentioning

confidence: 99%

Healthcare quality and mortality among patients hospitalized for heart failure by hospital level in Beijing, China

He¹,

Dong²,

et al. 2021

ESC Heart Failure

View full text Add to dashboard Cite

Aims This study sought to compare healthcare quality and 30 day, 90 day, and 1 year mortality rates among patients admitted to secondary and tertiary hospitals for heart failure (HF) in Beijing. Methods and results This study retrospectively enrolled patients hospitalized with a primary discharge diagnosis of HF during January 2014 to December 2015, from five tertiary and four secondary hospitals, in Beijing, China. Mortality data were extracted from Beijing Death Surveillance Database. HF healthcare quality indices were used to evaluate in-hospital care. Associations between hospital level and mortality rates were assessed using generalized linear mixed models, adjusting for patients' baseline characteristics and intra-hospital correlation. Data from 1413 patients (median [interquartile range] age = 74 [65-80] years, 52.7% female) from secondary hospitals and 1250 patients (median [interquartile range] age = 72 [61-79] years, 43.3% female) from tertiary hospitals were collected. Rates of left ventricular ejection fraction assessment (73.2% vs. 90.1%) and combined use of β-blockers and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (30.1% vs. 49.3%) were lower in secondary hospitals than those in tertiary hospitals, respectively. Patients admitted to secondary hospitals had a higher 90 day mortality [10.8% vs. 5.0%; adjusted odds ratio (OR): 2.06; 95% confidence interval (CI): 1.10-3.84, P = 0.024 and a higher 1 year mortality rate [21.0% vs. 12.1%; adjusted OR: 1.64; 95% CI: 1.02-2.62, P = 0.039], but 30 day mortality rates were not significantly different (5.5% vs. 3.0%; adjusted OR: 1.49; 95% CI: 0.63-3.52, P = 0.368). Conclusions Worse quality of care for patients with HF in secondary hospitals was associated with higher 90 day and 1 year mortality rates. Improving care quality in secondary hospitals is crucial to improve prognosis of patients they served.

show abstract

“…This is in line with a recent systematic review of systems of care for HF patients, which concluded that a suite of interventions led by a HF specialist workforce are needed across the continuum of care 11 . Quality improvement projects that improve compliance with guidelines have been shown to improve survival and readmission rates 12‐15 . We chose to implement intervention with evidence of improved outcomes, including comprehensive post‐discharge support, 16 a HF care bundle, 17 an early follow‐up clinic, 18 nurse‐led medication titration and patient education 19,20 …”

Section: Discussionmentioning

confidence: 69%

Impact of a model of care for heart failure in‐patients to reduce variation in care: a quality improvement project

Hopper

Easton

Bader

et al. 2021

Internal Medicine Journal

View full text Add to dashboard Cite

Background We identified variation in delivery of guideline recommended care at our institution, and undertook a project to design a heart failure (HF) model of care. Aim To maximise time patients with HF spend well in the community by delivering best practice guidelines to reduce variation in care improving overall outcomes. Methods This quality improvement project focused on reducing variation in process measures of care. The HF model of care included electronic HF care bundles, a patient education pack with staff training on delivering HF patient education, referral of all HF patients to the Hospital Admissions Risk Program for phone call within 72 h, and a nurse–pharmacist early follow‐up clinic. Outcomes were assessed using interrupted time series analyses. Results The pre‐intervention group comprised 1585 patients, and post‐intervention 1720 patients with a primary diagnosis of HF admitted under general cardiology and general medicine. Interrupted time series analysis indicated 30‐day readmissions did not change in overall trend (−0.2% per month, P = 0.479) but a significant immediate step‐down of 7.8% was seen (P = 0.018). For 90‐day readmissions, a significant trend reduction over the time period was seen (−0.6% per month, P = 0.017) with a significant immediate step‐down (−9.4%, P = 0.001). Emergency department representations, in‐patient mortality and length of stay did not change significantly. Improvements in process measures were seen at audit. Conclusion This model of care resulted in overall trends of reductions in 30‐ and 90‐day readmissions, without increasing emergency department representations, mortality and length of stay. This model will be adapted as the electronic medical record is introduced at our institution.

show abstract

Association between process performance measures and 1-year mortality among patients with incident heart failure: a Danish nationwide study

Abstract: Meeting process performance measures, which reflect care in concordance with clinical guideline recommendations, was associated with substantially lower 1-year mortality among patients with incident HF.

Cited by 16 publications

References 27 publications

Twenty‐year time trends in use of evidence‐based heart failure drug therapy in Denmark

Twenty‐year time trends in use of evidence‐based heart failure drug therapy in Denmark

Healthcare quality and mortality among patients hospitalized for heart failure by hospital level in Beijing, China

Impact of a model of care for heart failure in‐patients to reduce variation in care: a quality improvement project

Contact Info

Product

Resources

About