TY - JOUR
T1 - Association of hospital performance based on 30-day risk-standardized mortality rate with long-term survival after heart failure hospitalization. An analysis of the get with the guidelines-heart failure registry
AU - Pandey, Ambarish
AU - Patel, Kershaw V.
AU - Liang, Li
AU - DeVore, Adam D.
AU - Matsouaka, Roland
AU - Bhatt, Deepak L.
AU - Yancy, Clyde W.
AU - Hernandez, Adrian F.
AU - Heidenreich, Paul A.
AU - de Lemos, James A
AU - Fonarow, Gregg C.
N1 - Publisher Copyright:
© 2018 American Medical Association. All rights reserved.
PY - 2018/6
Y1 - 2018/6
N2 - IMPORTANCE Among patients hospitalized with heart failure (HF), the long-term clinical implications of hospitalization at hospitals based on 30-day risk-standardized mortality rates (RSMRs) is not known. OBJECTIVE To evaluate the association of hospital-specific 30-day RSMR with long-term survival among patients hospitalized with HF in the American Heart Association Get With The Guidelines-HF registry. DESIGN, SETTING, AND PARTICIPANTS The longitudinal observational study included 106 304 patients with HF who were admitted to 317 centers participating in the Get With The Guidelines-HF registry from January 1, 2005, to December 31, 2013, and had Medicare-linked follow-up data. Hospital-specific 30-day RSMR was calculated using a hierarchical logistic regression model. In the model, 30-day mortality rate was a binary outcome, patient baseline characteristics were included as covariates, and the hospitals were treated as random effects. The association of 30-day RSMR-based hospital groups (low to high 30-day RSMR: quartile 1 [Q1] to Q4) with long-term (1-year, 3-year, and 5-year) mortality was assessed using adjusted Cox models. Data analysis took place from June 29, 2017, to February 19, 2018. EXPOSURES Thirty-day RSMR for participating hospitals. MAIN OUTCOMES AND MEASURES One-year, 3-year, and 5-year mortality rates. RESULTS Of the 106 304 patients included in the analysis, 57 552 (54.1%) were women and 84 595 (79.6%) were white, and the median (interquartile range) age was 81 (74-87) years. The 30-day RSMR ranged from 8.6%(Q1) to 10.7%(Q4). Hospitals in the low 30-day RSMR group had greater availability of advanced HF therapies, cardiac surgery, and percutaneous coronary interventions. In the primary landmarked analyses among 30-day survivors, there was a graded inverse association between 30-day RSMR and long-term mortality (Q1 vs Q4: 5-year mortality, 73.7%vs 76.8%). In adjusted analysis, patients admitted to hospitals in the high 30-day RSMR group had 14%(95%CI, 10-18) higher relative hazards of 5-year mortality compared with those admitted to hospitals in the low 30-day RSMR group. Similar findings were observed in analyses of survival from admission, with 22%(95%CI, 18-26) higher relative hazards of 5-year mortality for patients admitted to Q4 vs Q1 hospitals. CONCLUSIONS AND RELEVANCE Lower hospital-level 30-day RSMR is associated with greater 1-year, 3-year, and 5-year survival for patients with HF. These differences in 30-day survival continued to accrue beyond 30 days and persisted long term, suggesting that 30-day RSMR may be a useful HF performance metric to incentivize quality care and improve long-term outcomes.
AB - IMPORTANCE Among patients hospitalized with heart failure (HF), the long-term clinical implications of hospitalization at hospitals based on 30-day risk-standardized mortality rates (RSMRs) is not known. OBJECTIVE To evaluate the association of hospital-specific 30-day RSMR with long-term survival among patients hospitalized with HF in the American Heart Association Get With The Guidelines-HF registry. DESIGN, SETTING, AND PARTICIPANTS The longitudinal observational study included 106 304 patients with HF who were admitted to 317 centers participating in the Get With The Guidelines-HF registry from January 1, 2005, to December 31, 2013, and had Medicare-linked follow-up data. Hospital-specific 30-day RSMR was calculated using a hierarchical logistic regression model. In the model, 30-day mortality rate was a binary outcome, patient baseline characteristics were included as covariates, and the hospitals were treated as random effects. The association of 30-day RSMR-based hospital groups (low to high 30-day RSMR: quartile 1 [Q1] to Q4) with long-term (1-year, 3-year, and 5-year) mortality was assessed using adjusted Cox models. Data analysis took place from June 29, 2017, to February 19, 2018. EXPOSURES Thirty-day RSMR for participating hospitals. MAIN OUTCOMES AND MEASURES One-year, 3-year, and 5-year mortality rates. RESULTS Of the 106 304 patients included in the analysis, 57 552 (54.1%) were women and 84 595 (79.6%) were white, and the median (interquartile range) age was 81 (74-87) years. The 30-day RSMR ranged from 8.6%(Q1) to 10.7%(Q4). Hospitals in the low 30-day RSMR group had greater availability of advanced HF therapies, cardiac surgery, and percutaneous coronary interventions. In the primary landmarked analyses among 30-day survivors, there was a graded inverse association between 30-day RSMR and long-term mortality (Q1 vs Q4: 5-year mortality, 73.7%vs 76.8%). In adjusted analysis, patients admitted to hospitals in the high 30-day RSMR group had 14%(95%CI, 10-18) higher relative hazards of 5-year mortality compared with those admitted to hospitals in the low 30-day RSMR group. Similar findings were observed in analyses of survival from admission, with 22%(95%CI, 18-26) higher relative hazards of 5-year mortality for patients admitted to Q4 vs Q1 hospitals. CONCLUSIONS AND RELEVANCE Lower hospital-level 30-day RSMR is associated with greater 1-year, 3-year, and 5-year survival for patients with HF. These differences in 30-day survival continued to accrue beyond 30 days and persisted long term, suggesting that 30-day RSMR may be a useful HF performance metric to incentivize quality care and improve long-term outcomes.
UR - http://www.scopus.com/inward/record.url?scp=85047542490&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85047542490&partnerID=8YFLogxK
U2 - 10.1001/jamacardio.2018.0579
DO - 10.1001/jamacardio.2018.0579
M3 - Article
C2 - 29532056
AN - SCOPUS:85047542490
SN - 2380-6583
VL - 3
SP - 489
EP - 497
JO - JAMA Cardiology
JF - JAMA Cardiology
IS - 6
ER -