Abstract
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.
Original language | English |
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Journal | European heart journal. Quality of care & clinical outcomes |
Volume | 5 |
Issue number | 1 |
Pages (from-to) | 28-34 |
Number of pages | 7 |
ISSN | 2058-1742 |
DOIs | |
Publication status | Published - Jan 2019 |
Keywords
- Clinical registries
- Heart failure
- Mortality
- Performance measures
- Angiotensin-Converting Enzyme Inhibitors/therapeutic use
- Heart Failure/diagnostic imaging
- Echocardiography
- Follow-Up Studies
- Humans
- Middle Aged
- Angiotensin II Type 1 Receptor Blockers/therapeutic use
- Male
- Treatment Outcome
- Adrenergic beta-Antagonists/therapeutic use
- Exercise Therapy
- Process Assessment (Health Care)
- Denmark/epidemiology
- Guideline Adherence
- Aged, 80 and over
- Female
- Registries
- Aged
- Patient Education as Topic
- Practice Guidelines as Topic