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Mar 26, 2018

Hospital Performance Closely Linked to Heart Failure Survival

Where you’re treated for heart failure matters, based on analysis of survival rates across hundreds of U.S. hospitals.

Where you’re treated for heart failure matters, based on a recent study that found heart failure patients treated at high-performing hospitals had better long-term survival.

Published in JAMA Cardiology, this study looked at the impact of hospital performance on five-year survival in patients with heart failure. It included more than 106,000 patients with heart failure who were treated across hundreds of U.S. hospital between 2005 and 2013. The goal was to see whether higher-performing hospitals, which was based on 30-day mortality rates, had any impact on long-term survival.

Thirty-day mortality is one of the ways hospitals are ranked on their quality of care. Mortality rates are based on treatment for common conditions like heart failure, which result in frequent hospital visits and drive health care costs. Currently, the U.S. Centers for Medicare and Medicaid Services can fine low-performing hospitals to help incentivize better care.

To test the impact of these metrics, researchers tracked outcomes of study participants for five years and compared survival rates by hospital.

A total of 106,304 patients were included in the analysis. More than half were women, and the average age was 81.

Overall, researchers found that patients treated at high-performing hospitals had 22% lower risk of 5-year mortality compared to hospitals that were low-performing. They also found that median survival was 138 days higher in patients treated at high-performing vs. low-performing centers.

“Implications for health policy are quite significant from this study,” explains Ambarish Pandey, MD, the lead author of this study. Findings show that 30-day mortality has a major impact on long-term survival in patients with heart failure. While 30-day mortality is one of the ways the U.S. Centers for Medicare and Medicaid Services rates hospitals on their quality of care, it’s not the only way.

As Pandey explains, the U.S. Centers for Medicare and Medicaid Services balances multiple factors when rating hospitals on their care. “I think based on our findings, we need to tilt that balance back in favor of 30-day mortality, which is a more robust predictor of long term survival,” said Pandey.

Heart failure affects 5.7 million Americans and costs the nation an estimated $30.7 billion each year. Experts hope that findings highlight the importance of how we evaluate quality of care and improve outcomes for patients with heart failure.

Authors note that additional research is needed to explore the factors that impact long-term survival in heart failure patients after hospitalization.

“There were some differences in the quality of care that was provided during the index hospitalization that may explain some of the observed differences in long term survival” said Pandey. “But to better understand it more comprehensively, I think we need to do further studies to look at what happens after discharge that may be making a difference as well.”

Questions for You to Consider

  • What is heart failure?

  • Heart failure occurs when the heart is unable to pump enough blood to the rest of the body. Although there is no cure for heart failure, treatments such as ACE inhibitors and ARBs can help improve outcomes as well as quality of life.
  • What are common heart failure symptoms?

  • Heart failure symptoms often present themselves slowly but progress and worsen over time. These symptoms include shortness of breath; swelling of feet, ankles or abdomen; fatigue; cough and weight gain.

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