Validity of Performance and Outcome Measures for Heart Failure

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Jay Patel1, Alex Sandhu1, Justin Parizo1

  • 1Stanford University School of Medicine, Department of Medicine, CA (J. Patel, A.S., J. Parizo, Y.M., P.A.H.).

Circulation. Heart Failure
|October 26, 2018
PubMed

Insights

Quality metrics for heart failure (HF) care are evaluated. Guideline-recommended therapies and mortality are valid HF quality measures, but 30-day readmission rates are not reliable indicators.

Area of Science:

  • Cardiology
  • Health Services Research
  • Quality Improvement

Background:

  • Numerous process and outcome quality metrics exist for heart failure (HF) care.
  • The emphasis on specific quality metrics requires validation to ensure they accurately reflect care quality.
  • Understanding the reliability and correlation of these metrics is crucial for effective quality assessment.

Purpose of the Study:

  • To determine the validity of existing heart failure quality metrics by assessing their correlations and reliability over time.
  • To identify which quality measures accurately reflect the quality of heart failure care.

Main Methods:

  • Observational cohort analysis of 55,735 patients hospitalized with HF from 102 Veterans Affairs medical centers (2008-2013).
  • Chart review and electronic resources were used to assess the use of guideline-recommended therapies: beta-blockers (BB), angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARB), and mineralocorticoid receptor antagonists.
  • Correlations between therapy use, 30-day mortality, 1-year mortality, and 30-day readmission rates were analyzed for convergent validity and reliability.

Main Results:

  • Significant correlations were observed between in-hospital ACE inhibitor use and BB use, 30-day mortality, and 1-year mortality.
  • Guideline-recommended BB use correlated significantly with mineralocorticoid receptor antagonist use, 30-day mortality, and 1-year mortality.
  • No correlation was found between 30-day readmission rates and any therapy or mortality measure. ACE inhibitor and readmission rates lacked reliability over time.

Conclusions:

  • Beta-blocker use, ACE inhibitor use, mortality rates, and mineralocorticoid receptor antagonist use are valid quality measures for heart failure care.
  • Thirty-day readmission rates appear to be an unreliable measure of heart failure quality of care.
  • Focusing on improving the utilization of recommended therapies may be a more effective strategy for enhancing heart failure care quality than solely emphasizing readmission reduction.

Keywords:
angiotensin-converting enzyme inhibitorsheart failurehydralazinemineralocorticoid receptor antagonistsoutcome assessmentpatient readmissionveterans

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