ORLANDO, Fla. — Patients who were hospitalized with acute HF at high-performing hospitals had improved long-term survival compared with those hospitalized at low-performing hospitals, according to data presented at the American College of Cardiology Scientific Session.
“These findings suggest that the performance metric based on 30-day [risk standardized mortality rate] may be useful to incentivize quality care and improve long-term outcomes in patients hospitalized with heart failure,” Ambarish Pandey, MD, second-year clinical fellow at the University of Texas Southwestern Medical Center in Dallas, said during the presentation.
Researchers analyzed available CMS data from 106,304 patients older than 65 years from 317 centers that participated in the Get With the Guidelines-Heart Failure (GWTG-HF) registry from 2005 to 2013. The primary exposure variable of interest was 30-day risk standardized mortality rate, which was adjusted for patient-level covariates. This mortality rate was used to stratify hospitals into four quartiles.
The primary outcome of interest was 5-year all-cause mortality.
High-performing centers had greater primary PCI capabilities, in-house cardiac surgery and heart transplant centers compared with other centers.
Postdischarge HF follow-up was higher in high-performing centers vs. centers in the other quartiles. These centers also had higher utilization of implantable cardioverter defibrillators and cardiac resynchronization therapy during the index hospitalization.
Hospital performance was related to long-term survival. The highest-performing centers had a median survival of 717 days (95% CI, 700-734) compared with the lowest-performing centers (579 days; 95% CI, 565-594). Similar trends were seen in 5-year mortality in the highest-performing centers (75.6%) and the lowest-performing centers (79.6%).
In an analysis on patients who survived 30 days, highest-performing centers had higher rates of median survival (832 days) and lower 5-year mortality (73.7%) compared with the lowest-performing centers (759 days, 76.8%, respectively).
After adjusting for patient- and hospital-level covariates, the rate of 5-year mortality increased as performance in centers decreased. The lowest-performing centers had a 22% increased risk for 5-year mortality compared with other quartiles. Similar findings were seen in 30-day survivors.
Gregg C. Fonarow
“Taken together, these findings suggest that greater use of evidence-based, life-prolonging therapies and greater postdischarge follow-up care may contribute, at least in part, to better long-term survival at hospitals with low 30-day [risk standardized mortality rates],” Pandey and colleagues wrote in a simultaneous publication in JAMA Cardiology.
“These findings strongly suggest that when it comes to pay-for-performance programs and value-based care, hospitals’ 30-day risk standardized mortality rate is a superior patient-centered metric compared to 30-day risk standardized rehospitalization rates, which have previously shown to have no or even an inverse relationship to long-term outcomes in heart failure,” Gregg C. Fonarow, MD, co-chief of cardiology at UCLA and senior author of the study, told Cardiology Today. – by Darlene Dobkowski
Pandey A, et al. Featured Interventional Clinical Research III. Presented at: American College of Cardiology Scientific Session; March 10-12, 2018; Orlando, Fla.
Pandey A, et al. JAMA Cardiol. 2018;doi:10.1001/jamacardio.2018.0579.
Disclosures: The GWTG-HF program is supported by the American Heart Association and has been previously funded by the AHA Pharmaceutical Roundtable, GlaxoSmithKline, Medtronic and Ortho-McNeil. Pandey reports no relevant financial disclosures. Fonarow reports he received consultant fees/honoraria from Amgen, Janssen, Medtronic, Novartis and St. Jude Medical and research support from Medtronic and Novartis.