News | Heart Failure | February 01, 2018

Guideline Adherence, Not Patient Volume, May Be Better Hospital Heart Failure Metric

In evaluating the quality of inpatient heart failure care, patients and policymakers should consider how well a hospital meets clinical care guidelines.

Guideline Adherence, Not Patient Volume, May Be Better Hospital Heart Failure Metric

February 1, 2018 –  In evaluating the quality of care given to those hospitalized with heart failure, adherence to clinical guidelines may be a better measure of quality than the number of heart failure patients a hospital admits, according to new research in the American Heart Association’s journal Circulation

Patients with heart failure are unable to pump enough blood and oxygen to their bodies to remain healthy. According to the American Heart Association’s 2017 Heart Disease and Stroke Statistical Update, 6.5 million Americans suffer from this chronic condition—and that number is growing.

“There is a feeling that hospitals that perform more procedures or treat more patients for a certain condition are likely to have better outcomes,” said lead study author Dharam Kumbhani, M.D. S.M, assistant professor of medicine and a cardiologist at UT Southwestern Medical Center in Dallas. “But what we have found in this study, and others we have conducted, is that patients at hospitals with established processes of care fare better.”

Researchers studied the medical records of 125,595 patients, age 65 and older, with heart failure who were treated at 342 hospitals participating in the American Heart Association’s Get With The Guidelines─Heart Failure program from 2005, when the program launched, through 2014. The goal of the program is to improve in-hospital care through adherence to the latest scientific treatment guidelines. Yearly admissions to a participating hospital ranged from 5 to 457 heart failure patients.

The study found:

  • Hospitals with a higher volume of heart failure patients were more likely to adhere to “heart failure process measures,” including appropriate testing, drug therapies and smoking cessation counseling.
  • Higher heart-failure-volume hospitals were much more likely to place or prescribe upon discharge cardiac resynchronization therapy devices and implantable cardioverter defibrillators, which are medical devices that improve heart function by restoring a normal heart beat.
  • There was no difference in in-hospital mortality, readmissions to the hospital or mortality 30 days after discharge between large-volume and small-volume hospitals when the hospitals closely followed the guidelines.
  • However, there was a slight decrease in hospital readmission and mortality 6 months after discharge between large-volume and small-volume hospitals when hospitals closely followed the guidelines.

Researchers adjusted their findings for a range of other medical conditions and demographic differences that may have biased results, including other cardiovascular and non-cardiovascular conditions, age, race, laboratory and clinical findings, prior medication and procedures performed during the initial hospitalization.

“Going to a high-volume medical center for heart failure doesn’t guarantee that you’ll have the best outcomes,” Kumbhani said. “Identifying the hospitals that provide the best care is more complicated than that, and patients and health policymakers should recognize that smaller-volume hospitals can deliver outstanding care.” Many of these hospitals are located in rural areas, where patients may not have access to a hospital that treats large numbers of heart failure patients.

He added that hospitals meeting the American Heart Association’s heart failure guidelines are recognized publicly for their achievements.

Study limitations include the fact that hospitals’ participation in the heart failure guidelines program is voluntary, so results may not be generalizable to all hospitals.

Access the article at http://circ.ahajournals.org/content/early/2018/01/23/CIRCULATIONAHA.117.028077

For more information: heart.org and strokeassociation.org

Related Content

A key slide from Elnabawi's presentation, showing cardiac CT plaque evaluations, showing the impact of psoriasis medication on coronary plaques at baseline and one year of treatment. It shows a reversal of vulnerable plaque development. #SCAI, #SCAI2018

A key slide from Elnabawi's presentation, showing cardiac CT plaque evaluations, showing the impact of psoriasis medication on coronary plaques at baseline and one year of treatment. It shows a reversal of vulnerable plaque development.  

Feature | Cardiovascular Clinical Studies | May 14, 2018
May 14, 2018 – New clinical evidance shows common therapy options for psoriasis (PSO), a chronic inflammatory skin di
Intravenous Drug Use is Causing Rise in Heart Valve Infections, Healthcare Costs. #SCAI, #SCAI2018
News | Cardiovascular Clinical Studies | May 14, 2018
May 14, 2018 — The opioid drug epidemic is impacting cardiology, with a new study finding the number of patients hosp
Patient Enrollment Completed in U.S. IDE Study of THERMOCOOL SMARTTOUCH SF Catheter
News | Cardiovascular Clinical Studies | March 15, 2018
March 15, 2018 –  Johnson & Johnson Medical Devices Companies announced today that Biosense Webster, Inc., who wo
Lexington Begins HeartSentry Clinical Trial
News | Cardiovascular Clinical Studies | February 20, 2018
February 20, 2018 – Lexington Biosciences, Inc., a development-stage medical device company, announced the commenceme
Endologix Completes Patient Enrollment in the ELEVATE IDE Clinical Study
News | Cardiovascular Clinical Studies | February 06, 2018
February 6, 2018 – Endologix, a developer and marketer of treatments for aortic disorders, announced the completion o
12-Month Results from Veryan Medical's MIMICS-2 IDE Study Presented at LINC
News | Cardiovascular Clinical Studies | February 01, 2018
February 1, 2018 – Thomas Zeller (Bad Krozingen, Germany) presented the 12-month results from Veryan Medical’s MIMICS
LimFlow Completes U.S. Feasibility Study Enrollment, Receives FDA Device Status
News | Cardiovascular Clinical Studies | February 01, 2018
February 1, 2018 –  LimFlow SA, developer of minimally-inv
ESC 2017 late breaking trial hot line study presentations.
News | Cardiovascular Clinical Studies | September 12, 2017
September 12, 2017 – The European Society of Cardiology (ESC) Congress 2017 includes several Hot Line Late-breaking C
U.K., NHS studies, weekend effect, hospital admission, atrial fibrillation, heart failure
News | Cardiovascular Clinical Studies | June 28, 2016
New research shows patients admitted to National Health Service (NHS) hospitals in the United Kingdom for atrial...
stroke risk
News | Cardiovascular Clinical Studies | August 28, 2015
Most people assume strokes only happen to octogenarians, but recent evidence suggests that survivors of childhood can
Overlay Init