Guideline adherence—not patient volume—linked to better heart failure care

Patient volume has been used to assess a hospital’s quality in treating certain conditions. The more experienced a facility is, the thinking goes, the more likely it will provide proper care.

However, a new analysis in Circulation suggests low-volume centers that follow clinical guidelines are able to provide the same level of care in treating heart failure as higher-volume centers.

“There is a feeling that hospitals that perform more procedures or treat more patients for a certain condition are likely to have better outcomes. But what we have found in this study, and others we have conducted, is that patients at hospitals with established processes of care fare better,” lead study author Dharam Kumbhani, MD, SM, a cardiologist at UT Southwestern Medical Center in Dallas, said in a press release.

Researchers studied more than 125,000 patients admitted to 342 hospitals for heart failure from 2005 through 2014. All of the hospitals participated in the Get With the Guidelines—Heart Failure program, which was designed to improve care through adherence to the latest scientific treatment guidelines.

Hospitals with a higher volume of heart failure patients were more likely to adhere to those processes, including appropriate testing, drug therapies and smoking cessation counseling, Kumbhani et al. reported. They were also more likely use cardiac resynchronization therapy and implantable cardioverter defibrillators.

But when hospitals closely followed the guidelines, there was no significant difference in risk-adjusted 30-day readmissions or risk-adjusted 30-day mortality between low-volume and high-volume centers. There were 2 percent reductions in six-month readmissions and six-month mortality for large-volume centers versus small-margin centers.

“Our analysis of a large contemporary prospective national quality improvement registry of older patients with (heart failure) indicates that hospital volume as a structural metric correlates with process measures, but not with 30-day outcomes, and only marginally with outcomes up to 6 months of follow-up,” the authors wrote. “Hospital profiling should focus on participation in systems of care, adherence to process metrics, and risk-standardized outcomes rather than on hospital volume itself.”