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Evidence-Based Process Performance Measures and Clinical Outcomes in Patients With Incident Heart Failure With Reduced Ejection Fraction: A Danish Nationwide Cohort Study.

Publication ,  Journal Article
Schjødt, I; Johnsen, SP; Strömberg, A; DeVore, AD; Valentin, JB; Løgstrup, BB
Published in: Circ Cardiovasc Qual Outcomes
April 2022

BACKGROUND: Data on the association between quality of heart failure (HF) care and outcomes among patients with incident HF are sparse. We examined the association between process performance measures and clinical outcomes in patients with incident HF with reduced ejection fraction. METHODS: Patients with incident HF with reduced ejection fraction (n=10 966) between January 2008 and October 2015 were identified from the Danish HF Registry. Data from public registries were linked. Multivariable regression analyses were used to assess the association between 6 guideline-recommended HF care processes (New York Heart Association assessment, use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, beta-blockers, and mineralocorticoid receptor antagonists, exercise training, and patient education) and all-cause and HF readmission, all-cause and HF hospital days, and mortality within 3 to 12 months after HF diagnosis. The associations were analyzed according to the percentages of all relevant performance measures fulfilled for the individual patient (0%-50% [reference group], >50%-75%, and >75%-100%) and for the individual performance measures. RESULTS: Fulfilling >75% to 100% of the performance measures (n=5341 [48.7%]) was associated with lower risk of all-cause readmission (adjusted hazard ratio, 0.78 [95% CI, 0.68-0.89]) and HF readmission (adjusted hazard ratio, 0.71 [95% CI, 0.54-0.92]), lower use of all-cause hospital days (adjusted mean ratio, 0.73 [95% CI, 0.70-0.76]) and HF hospital days (adjusted mean ratio, 0.79 [95% CI, 0.70-0.89]), and lower mortality (adjusted hazard ratio, 0.42 [95% CI, 0.32-0.53]). A dose-response relationship was observed between fulfilling more performance measures and mortality (adjusted hazard ratio, 0.62 [95% CI, 0.49-0.77] fulfilling >50%-75% of the measures). Fulfilling individual performance measures, except mineralocorticoid receptor antagonist therapy, was associated with lower adjusted all-cause readmission, lower adjusted use of all-cause and HF hospital days, and lower adjusted mortality. CONCLUSIONS: Fulfilling more process performance measures was associated with better clinical outcomes in patients with incident HF with reduced ejection fraction.

Duke Scholars

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Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

April 2022

Volume

15

Issue

4

Start / End Page

e007973

Location

United States

Related Subject Headings

  • Stroke Volume
  • Registries
  • Mineralocorticoid Receptor Antagonists
  • Humans
  • Heart Failure
  • Denmark
  • Cohort Studies
  • Cardiovascular System & Hematology
  • Angiotensin Receptor Antagonists
  • Adrenergic beta-Antagonists
 

Citation

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Schjødt, I., Johnsen, S. P., Strömberg, A., DeVore, A. D., Valentin, J. B., & Løgstrup, B. B. (2022). Evidence-Based Process Performance Measures and Clinical Outcomes in Patients With Incident Heart Failure With Reduced Ejection Fraction: A Danish Nationwide Cohort Study. Circ Cardiovasc Qual Outcomes, 15(4), e007973. https://doi.org/10.1161/CIRCOUTCOMES.121.007973
Schjødt, Inge, Søren P. Johnsen, Anna Strömberg, Adam D. DeVore, Jan B. Valentin, and Brian B. Løgstrup. “Evidence-Based Process Performance Measures and Clinical Outcomes in Patients With Incident Heart Failure With Reduced Ejection Fraction: A Danish Nationwide Cohort Study.Circ Cardiovasc Qual Outcomes 15, no. 4 (April 2022): e007973. https://doi.org/10.1161/CIRCOUTCOMES.121.007973.
Schjødt I, Johnsen SP, Strömberg A, DeVore AD, Valentin JB, Løgstrup BB. Evidence-Based Process Performance Measures and Clinical Outcomes in Patients With Incident Heart Failure With Reduced Ejection Fraction: A Danish Nationwide Cohort Study. Circ Cardiovasc Qual Outcomes. 2022 Apr;15(4):e007973.
Schjødt, Inge, et al. “Evidence-Based Process Performance Measures and Clinical Outcomes in Patients With Incident Heart Failure With Reduced Ejection Fraction: A Danish Nationwide Cohort Study.Circ Cardiovasc Qual Outcomes, vol. 15, no. 4, Apr. 2022, p. e007973. Pubmed, doi:10.1161/CIRCOUTCOMES.121.007973.
Schjødt I, Johnsen SP, Strömberg A, DeVore AD, Valentin JB, Løgstrup BB. Evidence-Based Process Performance Measures and Clinical Outcomes in Patients With Incident Heart Failure With Reduced Ejection Fraction: A Danish Nationwide Cohort Study. Circ Cardiovasc Qual Outcomes. 2022 Apr;15(4):e007973.

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

April 2022

Volume

15

Issue

4

Start / End Page

e007973

Location

United States

Related Subject Headings

  • Stroke Volume
  • Registries
  • Mineralocorticoid Receptor Antagonists
  • Humans
  • Heart Failure
  • Denmark
  • Cohort Studies
  • Cardiovascular System & Hematology
  • Angiotensin Receptor Antagonists
  • Adrenergic beta-Antagonists