Variations in quality of care for heart failure.
BACKGROUND
The objective of our study was to assess hospital-to-hospital variations for the management and treatment of heart failure (HF) patients.


METHODS
We performed a cross-sectional study among randomly selected patients with ICD-10 (International Classification of Disease, 10th revision) HF hospitalised in three Swiss university hospitals in 1999. Demographic characteristics, risk factors, symptoms and findings at admission and discharge medications were abstracted. The main outcome measure was the percentage of patients receiving appropriate management and treatment as defined by quality of care indicators derived from evidence-based guidelines. Quality indicators were considered only when they could be applied (no contra-indications).


RESULTS
Among 1153 eligible patients with HF the mean age (SD) was 75.3 (12.7), 54.3% were male. Among potential candidates for specific interventions left ventricular function (LVF) was determined in 68.5% of patients; 53.8% received target dose of angiotensin converting enzyme inhibitors (ACEI), 86.0% any dose of angiotensin receptor blockers; 21.9% b-blockers, and 62.1% anticoagulants at discharge. Compared to hospital B (reference), the adjusted odds ratios (OR) (95% CI) for LVF not determined were 3.82 (2.50 to 5.85) in hospital A and 3.25 (1.78 to 5.93) in hospital C. The adjusted OR (95% CI) for not receiving target dose ACEI was 1.76 (0.95 to 3.26) for hospital A and 3.20 (1.34 to 7.65) for hospital C compared to hospital B.


CONCLUSIONS
Apparently, important hospital-to-hospital variations in the quality of care given to patients with HF could have existed between three academic medical centers.
Luthi
Jean-Christophe
JC
Health Care Evaluation Unit, Institute of Social and Preventive Medicine, University of Lausanne, Switzerland. jean-christophe.luthi@CHUV.CH
McClellan
William M
WM
Flanders
W Dana
WD
Pitts
Stephen R
SR
Burnand
Bernard
B
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000704:Analysis of Variance; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D016507:Cardiology Service, Hospital / Q000592:standards*; D003430:Cross-Sectional Studies; D017723:Drug Utilization Review; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000188:drug therapy / Q000628:therapy*; D006785:Hospitals, University / Q000592:standards*; D006801:Humans; D008297:Male; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D013557:Switzerland
D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000925:Anticoagulants