Quality of care for heart failure patients hospitalized for any cause.
OBJECTIVE
The study sought to assess the quality of care for heart failure patients who are hospitalized for all causes.


BACKGROUND
Performance measures for heart failure target patients with a principal diagnosis of heart failure. However, patients with heart failure are commonly hospitalized for other causes and may benefit from treatments such as angiotensin-converting enzyme (ACE) inhibitors for left ventricular (LV) systolic dysfunction.


METHODS
We assessed rates of compliance with care measures for patients hospitalized with acute or chronic heart failure in the ARIC (Atherosclerosis Risk In Communities) study surveillance catchment area from 2005 to 2009. Rates of compliance were compared between patients with a principal discharge diagnosis of heart failure and those with another principal discharge diagnosis.


RESULTS
Of 4,345 hospitalizations of heart failure patients, 39.6% carried a principal diagnosis of heart failure. Patients with a principal heart failure diagnosis had higher rates of LV function assessment (89.1% vs. 82.5%; adjusted prevalence ratio [aPR]: 1.07; 95% confidence interval [CI]: 1.04 to 1.10) and discharge ACE inhibitor/angiotensin receptor blocker (ARB) in LV dysfunction (64.1% vs. 56.3%; aPR: 1.11; 95% CI: 1.03 to 1.20) as compared to patients hospitalized for another cause. LV assessment and ACE inhibitor/ARB use were associated with reductions in 1-year post-discharge mortality (adjusted odds ratio: 0.66, 95% CI: 0.51 to 0.85; adjusted odds ratio: 0.72, 95% CI: 0.54 to 0.96, respectively) that did not differ for patients with versus without a principal heart failure diagnosis.


CONCLUSIONS
Compared with individuals hospitalized with a principal diagnosis of heart failure, heart failure patients hospitalized for other causes were less likely to receive guideline recommended care. Quality initiatives may improve care by targeting hospitalizations with either principal or secondary heart failure diagnoses.
Department of Population Health, NYU School of Medicine, New York, New York; Department of Medicine, NYU School of Medicine, New York, New York. Electronic address: saul.blecker@nyumc.org.
Saul
S
Blecker
Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Sunil K
SK
Agarwal
Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
Patricia P
PP
Chang
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.
Wayne D
WD
Rosamond
Department of Population Health, NYU School of Medicine, New York, New York.
Donald E
DE
Casey
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.
Anna
A
Kucharska-Newton
Department of Medicine, NYU School of Medicine, New York, New York.
Martha J
MJ
Radford
Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Josef
J
Coresh
Department of Medicine, NYU School of Medicine, New York, New York.
Stuart
S
Katz
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011787:Quality of Health Care; D014481:United States
ACCF/AHA/AMA-PCPI; ACE; ARB; American College of Cardiology Foundation, American Heart Association, and American Medical Association–Physician Consortium for Performance Improvement; CI; CMS; COPD; Centers for Medicare and Medicaid Services; LV; OR; angiotensin receptor blocker; angiotensin-converting enzyme; chronic obstructive pulmonary disease; confidence interval; eGFR; estimated glomerular filtration rate; heart failure; hospitalization; left ventricular; odds ratio; quality of care