title: Was the decreasing trend in hospital mortality from heart failure attributable to improved hospital care? The Oregon experience, 1991-1995.
abstract: OBJECTIVE
  To assess the trend in risk-adjusted hospital mortality from heart failure.
  
  
  METHODS
  Oregon hospital discharge data from 1991 through 1995 were analyzed.
  
  
  METHODS
  A total of 29,530 hospitalizations because of heart failure in elderly patients (age > or = 65 years) were identified from International Classification of Diseases, 9th Revision, codes 428.0-428.9. The logistic regression and life table analyses were used to assess the risk-adjusted trend in hospital mortality from heart failure.
  
  
  RESULTS
  From 1991 through 1995, 1757 (5.9%) patients with heart failure died in the hospital; 920 (52.4%) of them died within 3 days. The percentage of patients discharged to skilled nursing facilities increased from 6.1% in 1991 to 9.8% in 1995 (P value for trend < .001), whereas the percentage of patients discharged directly to home decreased from 69.2% in 1991 to 62.4% in 1995 (P value for trend < .001). The mean length of stay decreased from 5.15 days in 1991 to 3.97 days in 1995. The age- and sex-standardized mortality rate decreased by 33.8% from 7.4 in 1991 to 4.8 in 1995 (P value for trend < .01). Additional adjustment for comorbidity using multiple logistic regression revealed a greater reduction of 41.0% in the mortality rate (odds ratio = 0.59; 95% confidence interval = 0.50, 0.69) and a reduction of 46.0% in the 3-day mortality rate (odds ratio = 0.54; 95% confidence interval = 0.43, 0.67) across the 5-year period. Life table analysis showed consistently lower cumulative mortality rates during the first week after admission in 1995 compared with those in 1991 (P < .001).
  
  
  CONCLUSIONS
  There was a decreasing trend over time in the risk-adjusted hospital mortality rates from heart failure, which was not an artifact of decreasing length of stay. Our findings raised the possibility of improved hospital care for heart failure in Oregon.
authors.affiliation: Oregon Heart Failure Project, Heart Failure Treatment Program, Division of Cardiology, Oregon Health Sciences University, Portland, USA. nih@ohsu.edu
authors.forename: H
authors.initials: H
authors.lastname: Ni
authors.forename: R E
authors.initials: RE
authors.lastname: Hershberger
mesh_terms: D000368:Aged; D016507:Cardiology Service, Hospital / Q000592:standards*; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006302:Health Services Research; D006333:Heart Failure / Q000401:mortality*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D015993:Life Tables; D008297:Male; D009922:Oregon / Q000453:epidemiology; D010351:Patient Discharge / Q000639:trends; D019984:Quality Indicators, Health Care; D012866:Skilled Nursing Facilities