Rong Fu1, Jing Xiang1, Han Bao1, Zhiqiang Wang2, Yupeng Wang1, Yongjie Chen1, Huimin Zhang1, Dan Liu1, Meina Liu3. 1. 1 Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, P.R. China. 2. 2 School of Medicine, the University of Queensland, Room 817, Health Sciences Building, Royal Brisbane & Women's Hospital, Herston, QLD 4029, Australia. 3. 1 Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, P.R. China liumeina369@163.com.
Abstract
BACKGROUND: Quality indicators for Chinese patients with chronic heart failure (CHF) have been developed. However, little is known about the compliance with quality indicators and the association between process indicators and in-hospital mortality in China. METHODS: Data from 1862 CHF admissions between 1 January 2009 and 31 October 2010 at 20 tertiary hospitals in Heilongjiang Province were analyzed. Hierarchical generalized linear models were used to examine the association between six process indicators and in-hospital mortality in eligible patients. RESULTS: The in-hospital mortality for the 1862 patients was 4.7%. The compliance with six process indicators were: evaluation of left ventricular function, 66.4%; angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB), 54.9%; diuretic, 86.2%; beta-blocker, 45.1%; aldosterone-receptor antagonist, 64.0%; and warfarin, 17.1%. Rates of compliance at the hospital level varied from 0 to 100%. After the adjustment for confounding factors, evaluation of left ventricular function, ACEI/ARB and aldosterone receptor antagonist were significantly associated with in-hospital mortality ([OR, 0.55; 95% CI, 0.33-0.93; P = 0.027], [OR, 0.33; 95% CI, 0.12-0.94; P = 0.040] and [OR, 0.35; 95% CI, 0.13-0.98; P = 0.046], respectively). CONCLUSIONS: There are considerable gaps between guidelines and clinical practice and variations across hospitals for the treatment of patients with CHF. Evaluation of left ventricular function, ACEI/ARB and aldosterone receptor antagonist will reduce the risk of in-hospital mortality. The association of other process indicators with clinical outcomes remain to be established.
BACKGROUND: Quality indicators for Chinese patients with chronic heart failure (CHF) have been developed. However, little is known about the compliance with quality indicators and the association between process indicators and in-hospital mortality in China. METHODS: Data from 1862 CHF admissions between 1 January 2009 and 31 October 2010 at 20 tertiary hospitals in Heilongjiang Province were analyzed. Hierarchical generalized linear models were used to examine the association between six process indicators and in-hospital mortality in eligible patients. RESULTS: The in-hospital mortality for the 1862 patients was 4.7%. The compliance with six process indicators were: evaluation of left ventricular function, 66.4%; angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB), 54.9%; diuretic, 86.2%; beta-blocker, 45.1%; aldosterone-receptor antagonist, 64.0%; and warfarin, 17.1%. Rates of compliance at the hospital level varied from 0 to 100%. After the adjustment for confounding factors, evaluation of left ventricular function, ACEI/ARB and aldosterone receptor antagonist were significantly associated with in-hospital mortality ([OR, 0.55; 95% CI, 0.33-0.93; P = 0.027], [OR, 0.33; 95% CI, 0.12-0.94; P = 0.040] and [OR, 0.35; 95% CI, 0.13-0.98; P = 0.046], respectively). CONCLUSIONS: There are considerable gaps between guidelines and clinical practice and variations across hospitals for the treatment of patients with CHF. Evaluation of left ventricular function, ACEI/ARB and aldosterone receptor antagonist will reduce the risk of in-hospital mortality. The association of other process indicators with clinical outcomes remain to be established.
Authors: Marcus Ngantcha; Marie-Annick Le-Pogam; Sophie Calmus; Catherine Grenier; Isabelle Evrard; Agathe Lamarche-Vadel; Grégoire Rey Journal: BMC Health Serv Res Date: 2017-08-22 Impact factor: 2.655
Authors: Xinghe Huang; Yuan Yu; Xi Li; Fredrick A Masoudi; John A Spertus; Xiaofang Yan; Harlan M Krumholz; Lixin Jiang; Jing Li Journal: BMJ Open Date: 2019-02-19 Impact factor: 2.692
Authors: Yuan Yu; Aakriti Gupta; Chaoqun Wu; Frederick A Masoudi; Xue Du; Jian Zhang; Harlan M Krumholz; Jing Li Journal: J Am Heart Assoc Date: 2019-08-21 Impact factor: 5.501
Authors: Yuan Yu; Hongzhao Zhang; Xi Li; Yuan Lu; Frederick A Masoudi; Harlan M Krumholz; Jing Li Journal: BMJ Open Date: 2018-05-10 Impact factor: 2.692