 |
|
Ten-Year Trends in Hospital Care for Congestive Heart Failure
Improved Outcomes and Increased Use of Resources
Carísi A. Polanczyk, MD, MSc;
Luis E. P. Rohde, MD, MSc;
G. William Dec, MD;
Thomas DiSalvo, MD, MSc
Arch Intern Med. 2000;160:325-332.
Background Scarce data are available on long-term trends in hospital mortality, length of stay (LOS), and costs in congestive heart failure (CHF).
Objective To assess 10-year trends in the outcomes of patients hospitalized with CHF.
Methods We studied all 6676 patients with a primary discharge diagnosis of CHF hospitalized from January 1, 1986, through July 31, 1996, at an academic tertiary care center. Hospital mortality, LOS, and costs were adjusted for sociodemographic characteristics, comorbidities, invasive procedures, hospital disposition, and LOS where appropriate.
Results The mean (±SD) age of patients was 70 ± 13 years; 54.1% were male; 87.0% were white. There was a significant increasing trend in heart failure severity as assessed by a CHF-specific risk-adjustment index. The proportion of patients who underwent invasive procedures (eg, cardiac catheterization, coronary angioplasty, coronary artery bypass surgery, defibrillator and pacemaker implantation) was significantly higher in the 1994-1996 period. The standardized mortality ratio (observed mortality/predicted mortality) progressively fell during the study period. Compared with patients admitted before 1991, those admitted after 1991 had a 24% lower observed than predicted mortality. Adjusted LOS exhibited a downward trend, ie, 7.7 days in 1986-1987 to 5.6 days in 1994-1996 (P<.001). Unadjusted cost peaked during 1992-1993 and declined thereafter. Adjusted costs in 1994-1996 were not significantly different from those in 1990-1991.
Conclusions After risk adjustment for sociodemographic characteristics, comorbidities, and disease severity, a significant decrease in in-hospital mortality was observed during the study decade. This decline in hospital mortality occurred in parallel with decreasing LOS and increasing use of cardiac procedures and costs.
From the Heart Failure and Cardiac Transplantation Unit, Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston.
RELATED ARTICLE
Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 2000;160(3):397-398.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Prevalence and impact of worsening renal function in patients hospitalized with decompensated heart failure: results of the prospective outcomes study in heart failure (POSH)
Cowie et al.
Eur Heart J 2006;27:1216-1222.
ABSTRACT
| FULL TEXT
The Business Case for Quality: Combining Medical Literature Research with Health Plan Data to Establish Value for Nonclinical Managers
Fetterolf and West
American Journal of Medical Quality 2004;19:48-55.
ABSTRACT
Beta-blockers and angiotensin-converting enzyme inhibitors/receptor blockers prescriptions after hospital discharge for heart failure are associated with decreased mortality in Alberta, Canada
Johnson et al.
J Am Coll Cardiol 2003;42:1438-1445.
ABSTRACT
| FULL TEXT
Trends and ethnic differences in hospital admissions and mortality for congestive heart failure in the elderly in Singapore, 1991 to 1998
Ng and Niti
Heart 2003;89:865-870.
ABSTRACT
| FULL TEXT
Heart failure etiology and response tomilrinone in decompensated heart failure: Results from the OPTIME-CHF study
Felker et al.
J Am Coll Cardiol 2003;41:997-1003.
ABSTRACT
| FULL TEXT
Relationship between hospital length of stay and quality of care in patients with congestive heart failure
Kossovsky et al.
Qual Saf Health Care 2002;11:219-223.
ABSTRACT
| FULL TEXT
B-Type Natriuretic Peptide and Clinical Judgment in Emergency Diagnosis of Heart Failure: Analysis From Breathing Not Properly (BNP) Multinational Study
McCullough et al.
Circulation 2002;106:416-422.
ABSTRACT
| FULL TEXT
Confirmation of a heart failure epidemic: findings from the Resource Utilization Among Congestive Heart Failure (REACH) study
McCullough et al.
J Am Coll Cardiol 2002;39:60-69.
ABSTRACT
| FULL TEXT
|
