TY - JOUR
T1 - Association between process performance measures and 1-year mortality among patients with incident heart failure
T2 - a Danish nationwide study
AU - Nakano, Anne
AU - Vinter, Nicklas
AU - Egstrup, Kenneth
AU - Svendsen, Marie Louise
AU - Schjødt, Inge
AU - Johnsen, Søren Paaske
PY - 2019/1
Y1 - 2019/1
N2 - Aims To examine the association between fulfilment of performance measures supported by clinical guidelines recommendations and 1-year mortality among patients with incident heart failure (HF) in Denmark. Methods and results A nationwide population-based follow-up study based on the Danish Heart Failure Registry. All Danish hospital departments caring for patients with HF. We identified 24 308 in- and outpatients diagnosed with HF from 2003 to 2010. Quality of care was defined as receiving the guideline recommended processes of care: use of echocardiography, New York Heart Association classification, treatment with angiotensin-converting-enzyme inhibitors/angiotensin-II-receptor blocker, beta blockers, physical training, and patient education. Main outcome measure is 1-year mortality. We used multiple imputation and multivariable Cox proportional hazard regression to compute hazard ratios (HRs) for 1-year mortality adjusted for potential confounding factors. Within 1 year, 17.1% of the patients died and the adjusted HRs ranged from 0.61 [95% confidence interval (CI) 0.55-0.67] for patient education to 0.99 (95% CI 0.90-1.10) for beta blocker therapy. The association between meeting more performance measures and 1-year mortality appeared to follow a dose-response pattern: using 0-25% of fulfilled measures as reference, patients who fulfilled 76-100% of the performance measures had an adjusted HR of 0.43 (95% CI 0.38-0.48), while the adjusted HR was 0.96 (95% CI 0.86-1.07) for patients who fulfilled between 26% and 50% of the performance measures. Conclusion Meeting process performance measures, which reflect care in concordance with clinical guideline recommendations, was associated with substantially lower 1-year mortality among patients with incident HF.
AB - Aims To examine the association between fulfilment of performance measures supported by clinical guidelines recommendations and 1-year mortality among patients with incident heart failure (HF) in Denmark. Methods and results A nationwide population-based follow-up study based on the Danish Heart Failure Registry. All Danish hospital departments caring for patients with HF. We identified 24 308 in- and outpatients diagnosed with HF from 2003 to 2010. Quality of care was defined as receiving the guideline recommended processes of care: use of echocardiography, New York Heart Association classification, treatment with angiotensin-converting-enzyme inhibitors/angiotensin-II-receptor blocker, beta blockers, physical training, and patient education. Main outcome measure is 1-year mortality. We used multiple imputation and multivariable Cox proportional hazard regression to compute hazard ratios (HRs) for 1-year mortality adjusted for potential confounding factors. Within 1 year, 17.1% of the patients died and the adjusted HRs ranged from 0.61 [95% confidence interval (CI) 0.55-0.67] for patient education to 0.99 (95% CI 0.90-1.10) for beta blocker therapy. The association between meeting more performance measures and 1-year mortality appeared to follow a dose-response pattern: using 0-25% of fulfilled measures as reference, patients who fulfilled 76-100% of the performance measures had an adjusted HR of 0.43 (95% CI 0.38-0.48), while the adjusted HR was 0.96 (95% CI 0.86-1.07) for patients who fulfilled between 26% and 50% of the performance measures. Conclusion Meeting process performance measures, which reflect care in concordance with clinical guideline recommendations, was associated with substantially lower 1-year mortality among patients with incident HF.
KW - Clinical registries
KW - Heart failure
KW - Mortality
KW - Performance measures
KW - Angiotensin-Converting Enzyme Inhibitors/therapeutic use
KW - Heart Failure/diagnostic imaging
KW - Echocardiography
KW - Follow-Up Studies
KW - Humans
KW - Middle Aged
KW - Angiotensin II Type 1 Receptor Blockers/therapeutic use
KW - Male
KW - Treatment Outcome
KW - Adrenergic beta-Antagonists/therapeutic use
KW - Exercise Therapy
KW - Process Assessment (Health Care)
KW - Denmark/epidemiology
KW - Guideline Adherence
KW - Aged, 80 and over
KW - Female
KW - Registries
KW - Aged
KW - Patient Education as Topic
KW - Practice Guidelines as Topic
UR - http://www.scopus.com/inward/record.url?scp=85059243975&partnerID=8YFLogxK
U2 - 10.1093/ehjqcco/qcy041
DO - 10.1093/ehjqcco/qcy041
M3 - Journal article
C2 - 30204858
SN - 2058-1742
VL - 5
SP - 28
EP - 34
JO - European heart journal. Quality of care & clinical outcomes
JF - European heart journal. Quality of care & clinical outcomes
IS - 1
ER -