Heart failure patients hospitalized for other causes less likely to receive guideline-recommended care

October 14, 2013

Compared to patients with a principal diagnosis of heart failure, heart failure patients hospitalized with a diagnosis other than heart failure had lower rates of guideline-concordant care including assessment of left ventricular (LV) function or prescription for an ACE inhibitor or angiotensin receptor blocker (ARB) at time of discharge, according to a study published in the October 9 Journal of the American College of Cardiology.

Compared to patients with a principal diagnosis of heart failure, heart failure patients hospitalized with a diagnosis other than heart failure had lower rates of guideline-concordant care including assessment of left ventricular (LV) function or prescription for an ACE inhibitor or angiotensin receptor blocker (ARB) at time of discharge, according to a study published in the October 9 Journal of the American College of Cardiology.

“These care measures were associated with reduced mortality for patients hospitalized with heart failure, regardless of the reason for hospitalization,” study author Saul Blecker, MD, MHS, of the NYU School of Medicine, told Formulary.

Dr Blecker and colleagues performed a cohort study of 4,345 patients hospitalized with heart failure in the surveillance component of the Atherosclerosis Risk in Communities (ARIC)  study, a prospective study of cardiovascular disease. ARIC began surveillance of hospital discharge records in its communities in 2005 as a way to study the prevalence of heart failure hospitalizations. Rates of compliance with quality-of-care measures were compared between patients with a principal discharge diagnosis of heart failure and those with another principal discharge diagnosis.

Patients not admitted specifically for heart failure were less likely to have an assessment of their LV function (82.5% vs 89.1%, adjusted prevalence ratio [aPR] 1.07, 95% CI; 1.04-1.10) than were patients hospitalized because of heart failure.

Patients with the primary diagnosis were also more likely to receive a discharge prescription for an ACE inhibitor or an ARB with LV dysfunction (64.1% vs 56.3%; aPR 1.11, 95% CI; 1.03-1.20) compared with those hospitalized for another cause.

Both LV assessment and ACE inhibitor/ARB use were associated with similar reductions in 1-year post-discharge mortality, whether a patient had a primary or secondary diagnosis of heart failure (adjusted odds ratios 0.66, 95% CI; 0.51-0.85 and 0.72, 95% CI; 0.54-0.96.).

“Inpatient quality of care has focused primarily on patients with acute heart failure, commonly identified by principal discharge diagnosis code,” Dr Blecker said. “However, patients with heart failure are commonly hospitalized for other causes and should benefit from many of the same treatments.

“We were interested in examining the quality of care for patients hospitalized with a principal diagnosis of heart failure and patients with heart failure who are admitted with another principal diagnosis,” he added.

These findings suggest that hospitals and managed care organizations may want to consider implementation of quality-improvement initiatives to improve the care of heart failure patient who are hospitalized for any cause, Dr Blecker said.