Outcomes and the quality of care for patients hospitalized with heart failure

Objective. The purpose of this study was to determine whether process quality indicators derived from evidence-based guidelines for heart failure patients were associated with outcome indicators (hospital mortality and readmissions). Design. A retrospective cohort-study among patients discharged with a primary or secondary International Classification of Disease, 10th revision (ICD-10) heart failure code from 1 January to 31 December 1999. Setting. The study was implemented in three Swiss academic medical centers. Study participants. Records of 1634 patients hospitalized with heart failure were abstracted. Demographic characteristics, risk factors, symptoms and findings at admission, and discharge characteristics were recorded. Main outcome measure. Process quality indicators were derived from evidence-based guidelines, related to appropriate management and treatment of heart failure patients. Hospital mortality was measured in a chart abstraction process. Thirty-day readmissions were calculated using administrative data from hospitals. Results. Among the three hospitals, 1153 patients with heart failure were eligible for this study. Mean age was 75.3 years (standard deviation 12.7) and 45.7% of patients were female. Ventricular function (VF) was determined in 69% of patients. The adjusted odds-ratios (OR) for the VF not determined were 1.74 [95% confidence interval (CI) 1.06-2.84] for hospital mortality and 0.75 (95% CI 0.47-1.18) for 30-day readmissions. Among patients with left ventricular systolic dysfunction and no contraindication to angiotensin-converting enzyme inhibitor (ACEI), 54% were prescribed target-dose ACEI or angiotensin receptor blockers at discharge, 32% received ACEI at less then target dose, and 14% received no ACEI at discharge. Adjusted ORs (95% CI) for readmissions were 0.89 (0.28-2.84) for no ACEI and 1.17 (0.56-2.43) for less than target ACEI compared with target dose. Conclusions. Among patients with heart failure, the determination of VF was associated with hospital mortality. However, process indicators derived from evidence-based guidelines were not related to early readmissions in three Swiss university hospitals.