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Association between performance measures and clinical outcomes in patients with heart failure in China: Results from
Shiyue Zheng1, Li Li2, Chao Jiang1
1Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China.
Insights
Adherence to heart failure (HF) performance measures in China is low, but higher compliance is linked to reduced mortality. Improving care quality for HF patients is crucial.
Area of Science:
- Cardiology
- Healthcare Quality
- Public Health
Background:
- Significant variation exists in hospital care quality across China.
- Studies on heart failure (HF) performance measures and patient prognosis are limited.
Purpose of the Study:
- To investigate the association between adherence to performance measures and clinical outcomes in Chinese HF patients.
- To clarify the impact of performance measures on HF patient prognosis in China.
Main Methods:
- Analysis of 4497 HF patients from the Heart Failure Registry of Patient Outcomes study.
- Categorization of patients into four groups based on composite performance scores.
- Utilized multiple imputation and Cox proportional-hazard regression models.
Main Results:
- Only 12.5% of patients met the top 25% performance measures; 33.5% met the bottom 25%.
- 1-year mortality was 22.2%, with higher rates in the lowest performance group (27.0% vs. 16.3%).
- Meeting top performance measures correlated with a lower 1-year mortality rate (aHR: 0.78, 95% CI: 0.61-0.98).
Conclusions:
- A dose-response relationship exists between performance measure compliance and mortality in HF patients.
- Increased adherence to performance measures is associated with decreased HF patient mortality.
- Urgent improvements in the quality of care for HF patients in China are recommended.
Background:
There is great heterogeneity in the quality of care among hospitals in China, but studies on the performance measures and prognosis of patients with heart failure (HF) are still deficient.
Hypothesis:
Performance measures have been used as a guideline to clinicans, however, the association between them and outcomes among HF patients in China remains unclear.
Methods:
We analyzed 4497 patients with HF from the Heart Failure Registry of Patient Outcomes study. Performance measures were determined according to the guidelines, and the patients were divided into four groups based on a composite performance score. Multiple imputation and Cox proportional-hazard regression models were used to assess the association between the performance measures and clinical outcomes.
Results:
Overall, only 12.5% of patients met the top 25% of the performance measures, whereas 33.5% of patients met the bottom 25% of the measures. A total of 992 (22.2%) patients died within 1 year, involving a larger proportion of patients who had met only the bottom 25% of the performance measures than had met the top 25% (27.0% vs. 16.3%, respectively). The patients who met the top 25% of the measures had a lower 1-year mortality rate (adjusted hazard ratio: 0.78, 95% confidence interval: 0.61-0.98).
Conclusions:
The association between performance measures and mortality appeared to follow a dose-response pattern with a larger degree of compliance with performance measures being associated with a lower mortality rate in patients with HF. Accordingly, the quality of care for patients with HF in China needs to be further improved.
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