Abstract 107: Quality Of Care In Heart Failure Patients Hospitalized For Any Cause

Abstract

Background: Hospital quality performance measures for heart failure (HF) target patients with a principal discharge diagnosis of HF. However, patients with chronic HF are commonly admitted for other causes and are recommended treatments such as angiotensin converting enzyme (ACE) inhibitors for left ventricular (LV) systolic dysfunction. The purpose of this study was to assess the quality of care for HF patients who are hospitalized for all causes. Methods: We conducted a community-wide surveillance of hospitalized patients with acute or chronic HF as part of the Atherosclerosis Risk in Communities (ARIC) Study from 2005-2009. HF diagnosis was validated by chart abstraction and adjudication by physician committee. We assessed rates of compliance for two available Centers for Medicare & Medicaid Services (CMS) inpatient quality measures: LV function assessment and discharge prescription for an ACE inhibitor or angiotensin receptor blocker (ARB) for patient with LV systolic dysfunction; rates were compared for HF patients with a principal ICD-9 discharge diagnosis of HF and those with another principal discharge diagnosis. Cox proportional hazard models were used to assess the association of quality measures with post-discharge mortality. Results: Of 4,345 hospitalizations of HF patients, 39.6% carried a principal discharge diagnosis of HF. Individuals with a principal discharge diagnosis of HF had higher rates of LV function assessment (89.1% versus 82.5%, p<0.0001; adjusted prevalence ratio (aPR) 1.07, 95% CI 1.04-1.10) and ACE inhibitor/ARB use in LV dysfunction (64.1% versus 56.3%, p<0.01; aPR 1.11, 95% CI 1.03-1.20) as compared to individuals hospitalized for another cause. LV assessment and ACE inhibitor/ARB use were associated with significant or near significant reductions in post-discharge mortality (adjusted hazard ratios 0.69, 95% CI 0.50-0.90 and 0.73, 95% CI 0.52-1.03, respectively). The associations between quality measures and post-discharge mortality did not differ for patients with versus without a primary discharge diagnosis of HF (p-interaction=0.8 for LV assessment; p-interaction=0.6 for ACE inhibitor/ARB use). Conclusions: Compared to individuals hospitalized with a principal diagnosis of heart failure, heart failure patients hospitalized for other causes are less likely to receive aspects of guideline recommended care. Quality initiatives may improve care and outcomes by targeting hospitalizations with both a principal and secondary HF diagnosis.