Trends in quality of care among patients with incident heart failure in Denmark 2003–2010: a nationwide cohort study

Abstract

BackgroundThe treatment of heart failure (HF) is complex and the prognosis remains serious. A range of strategies is used across health care systems to improve the quality of care for HF patients. We present results from a nationwide multidisciplinary initiative to monitor and improve the quality of care and clinical outcome of HF patients using indicator monitoring combined with systematic auditing.MethodsWe conducted a nationwide, population-based prospective study using data from the Danish Heart Failure Registry. The registry systematically monitors and audits the use of guideline recommended processes of care at Danish hospital departments treating incident HF patients. We identified patients registered between 2003 and 2010 (n = 24504) and examined changes in use of recommended processes of care and 1-year mortality.ResultsThe use of the majority of the recommended processes of care increased substantially from 2003 to 2010: echocardiography (from 62.7% to 90.5%; Relative Risk (RR) 1.45 (95% CI, 1.39-1.50)), New York Heart Association classification (from 29.4% to 85.5%; RR 2.91 (95% CI, 2.69-3.14)), betablockers (from 72.6% to 88.3%; RR 1.23 (95% CI, 1.15-1.29)), physical training (from 5.6% to 22.8%; RR 4.04 (95% CI, 2.96-4.52)), and patient education (from 49.3% to 81.4%; RR 1.65 (95% CI, 1.52-1.80)). Use of ACE/ATII inhibitors remained stable (from 92.0% to 93.2%; RR 1.01 (95% CI, 0.99-1.04)). During the same period, 1-year mortality dropped from 20.5% to 12.8% (adjusted Hazard Ratio 0.79 (95% CI, 0.65-0.96).ConclusionsUse of guideline recommended processes of care has improved among patients with incident HF included in the Danish Heart Failure Registry between 2003 and 2010. During the same period, a decrease in mortality was observed.

Mortality Risk Among Heart Failure Patients With Depression: A Nationwide Population‐Based Cohort Study

“…Data on socioeconomic variables, including gross income, employment, and education, were obtained from the Integrated Database for Labor Market Research (for the index year or for previous years, depending on data availability) . For a subcohort of heart failure patients, we retrieved data from the Danish Heart Failure Registry on smoking status, alcohol habits, LVEF values, and NYHA functional class . It has been mandatory for cardiologists to register all incident hospitalized heart failure cases in this nationwide registry since 2003.…”

“…Patients with ICD‐10 codes for heart failure are enrolled in the registry if they fulfill the European Society of Cardiology's definition of heart failure. Regular structured audits are conducted to ensure the high quality of the registry's data . All ICD and ATC codes used in the study are provided in Table S1.…”

How to best assess quality of drug treatment in patients with heart failure

“…d Bland-Altman graph comparing the proportion of treated patients, calculated by method prescribing from all providers to all patients (any/any) with the method self-reported data from each primary care center; rhoc = 0.19 (0.11-0.28). Open circles represent observation with mean value of measurements as Bx^and their difference as By.^Dashed black lines show mean measurement error, and solid black lines show limits of agreement at 95 % Table 3 Multi-level analysis for patients with a diagnosis of heart failure in 2012 and the odds ratio for treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB) depending on methodology and study populations [22,23]. Shortening the observation period suggested slightly higher proportions.…”

Utilidad de los programas de intervención en el control evolutivo de los pacientes con insuficiencia cardiaca

“…Este dato es relevante, ya que diversos estudios han observado una mejoría del pronóstico con el uso de estos fármacos en pacientes asintomáticos con disfunción sistólica del ventrículo izquierdo, evitando así la progresión a IC sintomática, disminuyendo y previniendo el remodelado ventricular, y aumentado así la supervivencia 13 . La mayor adherencia terapéutica en los pacientes con IC con un seguimiento más estricto se ha observado en estudios previos, sobre todo en referencia al aumento del uso de BB [14][15][16] . Nuestro trabajo revela también un descenso de la tasa de exitus y un aumento de la supervivencia en el grupo de intervención de alta intensidad (seguido en consultas), en comparación con el grupo control.…”

“…Nuestro trabajo revela también un descenso de la tasa de exitus y un aumento de la supervivencia en el grupo de intervención de alta intensidad (seguido en consultas), en comparación con el grupo control. Estos datos concuerdan con la literatura revisada, apreciándose descensos de la tasa de mortalidad en un año tras el diagnóstico de IC con el incremento de la adherencia terapéutica y con intervenciones sobre los hábitos de vida, tales como el ejercicio físico y la educación higiénico-dietética 14 . Con este tipo de intervención también se han observado mejorías en la calidad de vida 17 , inclusive con intervenciones tipo taller para el mejor conocimiento de la enfermedad y el mantenimiento de hábitos de vida saludables sin modificación del tratamiento farmacológico 18 .…”