Validity of Performance and Outcome Measures for Heart Failure

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.