Association between process indicators and in-hospital mortality among patients with chronic heart failure in China.
BACKGROUND
Quality indicators for Chinese patients with chronic heart failure (CHF) have been developed. However, little is known about the compliance with quality indicators and the association between process indicators and in-hospital mortality in China.


METHODS
Data from 1862 CHF admissions between 1 January 2009 and 31 October 2010 at 20 tertiary hospitals in Heilongjiang Province were analyzed. Hierarchical generalized linear models were used to examine the association between six process indicators and in-hospital mortality in eligible patients.


RESULTS
The in-hospital mortality for the 1862 patients was 4.7%. The compliance with six process indicators were: evaluation of left ventricular function, 66.4%; angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB), 54.9%; diuretic, 86.2%; beta-blocker, 45.1%; aldosterone-receptor antagonist, 64.0%; and warfarin, 17.1%. Rates of compliance at the hospital level varied from 0 to 100%. After the adjustment for confounding factors, evaluation of left ventricular function, ACEI/ARB and aldosterone receptor antagonist were significantly associated with in-hospital mortality ([OR, 0.55; 95% CI, 0.33-0.93; P = 0.027], [OR, 0.33; 95% CI, 0.12-0.94; P = 0.040] and [OR, 0.35; 95% CI, 0.13-0.98; P = 0.046], respectively).


CONCLUSIONS
There are considerable gaps between guidelines and clinical practice and variations across hospitals for the treatment of patients with CHF. Evaluation of left ventricular function, ACEI/ARB and aldosterone receptor antagonist will reduce the risk of in-hospital mortality. The association of other process indicators with clinical outcomes remain to be established.
1 Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, P.R. China.
Rong
R
Fu
1 Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, P.R. China.
Jing
J
Xiang
1 Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, P.R. China.
Han
H
Bao
2 School of Medicine, the University of Queensland, Room 817, Health Sciences Building, Royal Brisbane & Women's Hospital, Herston, QLD 4029, Australia.
Zhiqiang
Z
Wang
1 Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, P.R. China.
Yupeng
Y
Wang
1 Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, P.R. China.
Yongjie
Y
Chen
1 Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, P.R. China.
Huimin
H
Zhang
1 Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, P.R. China.
Dan
D
Liu
1 Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, P.R. China liumeina369@163.com.
Meina
M
Liu
D000368:Aged; D002681:China / Q000453:epidemiology; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*