HFSA: High-volume hospitals have better outcomes, mortality for heart failure

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BOSTON—Large volume hospitals had better aggregate performance measures for acute decompensated heart failure, according to a poster presentation on Monday at the 13th annual meeting of the Heart Failure Society of America (HFSA).

Process performance measures are increasingly used to assess and reward hospital quality. Recent data on acute MI have shown the advantages of small-case volume on the hospital performance measures. According to the authors, little is know about how these measures correlate with case volume and mortality in acute decompensated heart failure.

In the analysis, Jun R. Chiong, MD, and colleagues from Loma Linda University School of Medicine in Loma Linda, Calif., sought to evaluate the strategy of early (less than 24 hours) versus pre-discharge initiation of carvedilol (GlaxoSmithKline’s Coreg) and the length of study in acute decompensated heart failure.

Using data from the U.S. Department of Health & Human Services, the researchers examined hospital performance for four publicly reported measures for heart failure: discharge education, left ventricular function assessment, ACE inhibitors or ARB use, and smoking cessation counseling. They reviewed data on 4,138 U.S. hospitals during the reporting period of April 2007 to March 2008.

The investigators determined hospital case volume based on the median number of cases for the particular quality performance measure. They also examined the association between hospital case volume, process performance and 30-day heart failure mortality rate.

According to the authors, sample sizes available for process performance assessment “varied considerably,” ranging from one patient to 2,241 patients per hospital.

Chiong and colleagues found that in aggregate, hospitals with larger heart failure case volumes had a better quality care performance measures. For lower volume hospitals, the discharge education was 72.5 percent, compared with 78.6 percent in high-case volume hospitals. For lower volume hospitals, left ventricular function assessment was 85.3 percent, compared with 96.1 percent in high-case volume hospitals. For low-case volume providers, ACE inhibitor or ARB therapy adherence was 86.8 percent, compared with 90.7 percent. Higher volume hospitals had a 96.8 percent score for smoking cessation counseling, compared with 88.6 percent in lower volume providers.

Likewise, they found that hospitals with larger case volumes have lower risk-adjusted 30-day failure mortality rate (12.2 percent), compared to hospitals with smaller case volumes (11.3 percent).

The authors said that their findings may be explained by the availability of resources to hospitals that handle a large volume of acute decompensated heart failure cases.