Hospital variation in intravenous inotrope use for patients hospitalized with heart failure: insights from Get With The Guidelines.

Published

Journal Article

BACKGROUND: Prior claims analyses suggest that the use of intravenous inotropic therapy for patients hospitalized with heart failure varies substantially by hospital. Whether differences in the clinical characteristics of the patients explain observed differences in the use of inotropic therapy is not known. METHODS AND RESULTS: We sought to characterize institutional variation in inotrope use among patients hospitalized with heart failure before and after accounting for clinical factors of patients. Hierarchical generalized linear regression models estimated risk-standardized hospital-level rates of inotrope use within 209 hospitals participating in Get With The Guidelines-Heart Failure (GWTG-HF) registry between 2005 and 2011. The association between risk-standardized rates of inotrope use and clinical outcomes was determined. Overall, an inotropic agent was administered in 7691 of 126 564 (6.1%) heart failure hospitalizations: dobutamine 43%, dopamine 24%, milrinone 17%, or a combination 16%. Patterns of inotrope use were stable during the 7-year study period. Use of inotropes varied significantly between hospitals even after accounting for patient and hospital characteristics (median risk-standardized hospital rate, 5.9%; interquartile range, 3.7%-8.6%; range, 1.3%-32.9%). After adjusting for case-mix and hospital structural differences, model intraclass correlation indicated that 21% of the observed variation in inotrope use was potentially attributable to random hospital effects (ie, institutional preferences). Hospitals with higher risk-standardized inotrope use had modestly longer risk-standardized length of stay (P=0.005) but had no difference in risk-standardized inpatient mortality (P=0.12). CONCLUSIONS: Use of intravenous inotropic agents during hospitalization for heart failure varies significantly among US hospitals even after accounting for patient and hospital factors.

Full Text

Duke Authors

Cited Authors

  • Allen, LA; Fonarow, GC; Grau-Sepulveda, MV; Hernandez, AF; Peterson, PN; Partovian, C; Li, S-X; Heidenreich, PA; Bhatt, DL; Peterson, ED; Krumholz, HM; American Heart Association’s Get With The Guidelines Heart Failure Investigators,

Published Date

  • March 1, 2014

Published In

Volume / Issue

  • 7 / 2

Start / End Page

  • 251 - 260

PubMed ID

  • 24488983

Pubmed Central ID

  • 24488983

Electronic International Standard Serial Number (EISSN)

  • 1941-3297

Digital Object Identifier (DOI)

  • 10.1161/CIRCHEARTFAILURE.113.000761

Language

  • eng

Conference Location

  • United States