Abstract P3: Socioeconomic Status a Better Predictor of Heart Failure Outcomes than Performance Measures

Abstract

BACKGROUND ACC/AHA published performance measures for patients admitted to hospitals with heart failure (HF) in 2005 with the goal to provide a standard of care. Hospitals have made significant changes to be compliant with these recommendations, however, there are limited data evaluating if these measures are responsible for decreasing morbidity and mortality. METHODS The US Department of Health and Human Services Hospital Compare database was used to identify patients admitted with a diagnosis of HF in 2008. Hospitals were excluded if they treated fewer than 25 HF patients or there was incomplete data collected. Inpatient performance measures for HF were defined as: evaluation of left ventricular (LV) systolic function, angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin-receptor blockers (ARB) for LV systolic dysfunction, smoking cessation counseling, and discharge instructions. Risk-adjusted 30-day mortality and readmission rates were also collected. Using hospital zip codes, catchment demographic data was correlated using US Census Bureau data from 2000. Statistical analysis was performed using ANOVA and multiple regression. RESULTS Analyses included 3,659 hospitals treating 1,059,640 patients. Hospitals reporting greater compliance with performance measures had significantly lower 30-day mortality and readmission rates. However, after controlling for individual measures and demographics, socioeconomic status consistently had a significant association with mortality and readmission rates. Only ACE-I/ARB use was associated with a lower readmission rate (p<0.001) for performance measures. CONCLUSION This study found that multiple socioeconomic factors but only 1 of 4 HF performance measures are significant predictors of improved HF outcomes. Further research to determine appropriate metrics of quality care for HF is necessary. Multivariable Analysis of Factors on Mortality and Readmission Rates Effect on Mortality Effect on Readmission Variable t ratio p value t ratio p value EF evaluation 0.5512 0.5816 1.715 0.0865 ACE/ARB 0.1014 0.9192 2.750 0.0060 Smoking cessation 0.9793 0.3275 0.1936 0.8465 Discharge instructions 0.7698 0.4415 1.014 0.3105 Age 0.2831 0.7771 0.8412 0.4003 Household income 8.928 <0.0001 5.968 <0.0001 % HS graduates 4.997 <0.0001 9.211 <0.0001 % White 5.479 <0.0001 0.6069 0.5440 % Black 0.6494 0.5161 3.184 0.0015 HF admissions 11.875 <0.0001 0.5310 0.5954