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Association between process indicators and in-hospital mortality among patients with chronic heart failure in China
Rong Fu1, Jing Xiang1, Han Bao1
11 Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, P.R. China.
Insights
Compliance with quality indicators for chronic heart failure (CHF) in China is low, but evaluating left ventricular function and using ACEI/ARB and aldosterone receptor antagonists reduce in-hospital mortality.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Quality indicators for chronic heart failure (CHF) management exist in China.
- Compliance and impact on mortality are not well understood.
Purpose of the Study:
- To assess compliance with quality indicators for CHF patients in China.
- To determine the association between process indicators and in-hospital mortality.
Main Methods:
- Analysis of 1862 CHF admissions from 20 tertiary hospitals in Heilongjiang Province.
- Hierarchical generalized linear models to assess the link between six process indicators and in-hospital mortality.
Main Results:
- In-hospital mortality was 4.7%.
- Compliance varied: Left ventricular function (66.4%), ACEI/ARB (54.9%), diuretics (86.2%), beta-blockers (45.1%), aldosterone antagonists (64.0%), warfarin (17.1%).
- Left ventricular function evaluation, ACEI/ARB, and aldosterone antagonists were associated with reduced in-hospital mortality (P < 0.05).
Conclusions:
- Significant gaps exist between CHF clinical practice guidelines and actual care in China.
- Key interventions like left ventricular function assessment and specific medications reduce mortality risk.
- Further research needed on other process indicators' impact.
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.
