title: Hospital-level variation in use of cardiovascular testing for adults with incident heart failure: findings from the cardiovascular research network heart failure study.
abstract: OBJECTIVE
  This study aimed to characterize the use of cardiovascular testing for patients with incident heart failure (HF) hospitalization who participated in the National Heart, Lung, and Blood Institute sponsored Cardiovascular Research Network (CVRN) Heart Failure study.
  
  
  BACKGROUND
  HF is a common cause of hospitalization, and testing and treatment patterns may differ substantially between providers. Testing choices have important implications for the cost and quality of care.
  
  
  METHODS
  Crude and adjusted cardiovascular testing rates were calculated for each participating hospital. Cox proportional hazards regression models were used to examine hospital testing rates after adjustment for hospital-level patient case mix.
  
  
  RESULTS
  Of the 37,099 patients in the CVRN Heart Failure study, 5,878 patients were hospitalized with incident HF between 2005 and 2008. Of these, evidence of cardiovascular testing was available for 4,650 (79.1%) patients between 14 days before the incident HF admission and ending 6 months after the incident discharge. We compared crude and adjusted cardiovascular testing rates at the hospital level because the majority of testing occurred during the incident HF hospitalization. Of patients who underwent testing, 4,085 (87.9%) had an echocardiogram, 4,345 (93.4%) had a systolic function assessment, and 1,714 (36.9%) had a coronary artery disease assessment. Crude and adjusted testing rates varied markedly across the profiled hospitals, for individual testing modalities (e.g., echocardiography, stress echocardiography, nuclear stress testing, and left heart catheterization) and for specific clinical indications (e.g., systolic function assessment and coronary artery disease assessment).
  
  
  CONCLUSIONS
  For patients with newly diagnosed HF, we did not observe widespread overuse of cardiovascular testing in the 6 months following incident HF hospitalization relative to existing HF guidelines. Variations in testing were greatest for assessment of ischemia, in which testing guidelines are less certain.
authors: Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Management and Strategy, Kellogg School of Management, Evanston, Illinois. Electronic address: safarmer@gwu.edu.
authors: Steven A
authors: SA
authors: Farmer
authors: Department of Management and Strategy, Kellogg School of Management, Evanston, Illinois.
authors: Justin
authors: J
authors: Lenzo
authors: Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado.
authors: David J
authors: DJ
authors: Magid
authors: Meyers Primary Care Institute, Worcester, Massachusetts; Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors: Jerry H
authors: JH
authors: Gurwitz
authors: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
authors: David H
authors: DH
authors: Smith
authors: Division of Research, Kaiser Permanente of Northern California, Oakland, California.
authors: Grace
authors: G
authors: Hsu
authors: Division of Research, Kaiser Permanente of Northern California, Oakland, California.
authors: Sue Hee
authors: SH
authors: Sung
authors: Division of Research, Kaiser Permanente of Northern California, Oakland, California; Departments of Epidemiology, Biostatistics, and Medicine, University of California, San Francisco, San Francisco, California; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California.
authors: Alan S
authors: AS
authors: Go
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D004452:Echocardiography / Q000706:statistics & numerical data; D025401:Echocardiography, Stress / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000628:therapy; D006334:Heart Function Tests / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D013599:Systole
keywords: cardiovascular testing; geographic variations; heart failure