title: Association between enrolment in a heart failure quality registry and subsequent mortality-a nationwide cohort study.
abstract: Heart failure (HF) quality registries report quality of care but it is unknown whether they improve outcomes. The aims were to assess predictors of enrolment in a HF registry, test the hypothesis that enrolment in a HF registry is associated with reduced mortality, and assess potential explanatory factors for this reduction in mortality, if present.
  
  
  
  We conducted a nationwide prospective cohort study of patients with new-onset HF registered in the Swedish National Patient Registry (NPR, a mandatory registry of ICD-code diagnoses) with or without concurrent registration in the Swedish Heart Failure Registry (SwedeHF, a voluntary quality reporting registry) 2006-2013. The association between demographics, co-morbidities and medications, and enrolment in the SwedeHF, was assessed using multivariable logistic regression. The association between enrolment in the SwedeHF and all-cause mortality was assessed using multivariable Cox regression, with adjustment for demographics, co-morbidities and medications. A total of 231 437 patients were included, of which 21 888 (9.5%) were in the SwedeHF [age (mean ± standard deviation) 74 ± 13 years; 41% women; 68% inpatients] and 209 549 (90.5%) were not (age 78 ± 12 years, 50% women; 79% inpatients). Selected variables independently associated with enrolment in the SwedeHF were male sex, younger age, higher education, absent co-morbidities and co-morbidity-related medications, and use of HF and cardiovascular medications. Over a median (interquartile range) follow-up of 874 (247-1667) days, there were 13.0 vs. 20.8 deaths per 100 patient-years (P < 0.001). The hazard ratio (95% confidence interval) for death for the SwedeHF yes vs. no was 0.65 (0.63-0.66) crude, and increased to 0.80 (0.78-0.81) after adding demographics, to 0.82 (0.80-0.84) after adding co-morbidities and co-morbidity-related medications, to 0.95 (0.93-0.97) after adding cardiovascular medications, and to 1.04 (1.02-1.07) after adding HF-specific medications.
  
  
  
  Heart failure patients of male sex, younger age, and higher education were more likely to be enrolled in a HF quality registry. Enrolment was associated with reduced all-cause mortality that was explained by demographic differences and better utilization of cardiovascular and HF medications.
authors.affiliation: Department of Medicine, Karolinska Institute, Stockholm, Sweden.|Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Lars H
authors.initials: LH
authors.lastname: Lund
authors.affiliation: Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
authors.forename: Juan-Jesus
authors.initials: JJ
authors.lastname: Carrero
authors.affiliation: Epi-Consultant, Stockholm, Sweden.
authors.forename: Bahman
authors.initials: B
authors.lastname: Farahmand
authors.affiliation: Department of Medical Sciences, Uppsala University, Uppsala, Sweden.|AstraZeneca RD, Mölndal, Sweden.
authors.forename: Karin M
authors.initials: KM
authors.lastname: Henriksson
authors.affiliation: Department of Medicine, Division of Cardiology, County Hospital Ryhov, Jönköping, Sweden.
authors.forename: Åsa
authors.initials: Å
authors.lastname: Jonsson
authors.affiliation: Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.|Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
authors.forename: Tomas
authors.initials: T
authors.lastname: Jernberg
authors.affiliation: Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Dahlström
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D015897:Comorbidity; D003710:Demography; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012042:Registries / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology
chemical_list: D002317:Cardiovascular Agents
keywords: Epidemiology; Evidence-based medicine; Guidelines; Heart failure; Registry