Association between process performance measures and 1-year mortality among patients with incident heart failure: a Danish nationwide study

Anne Nakano, Nicklas Vinter, Kenneth Egstrup, Marie Louise Svendsen, Inge Schjødt, Søren Paaske Johnsen

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Aims: To examine the association between fulfilment of performance measures supported by clinical guidelines recommendations and 1-year mortality among patients with incident heart failure (HF) in Denmark. Methods and results: A nationwide population-based follow-up study based on the Danish Heart Failure Registry. All Danish hospital departments caring for patients with HF. We identified 24 308 in- and outpatients diagnosed with HF from 2003 to 2010. Quality of care was defined as receiving the guideline recommended processes of care: use of echocardiography, New York Heart Association classification, treatment with angiotensin-converting-enzyme inhibitors/angiotensin-II-receptor blocker, beta blockers, physical training, and patient education. Main outcome measure is 1-year mortality. We used multiple imputation and multivariable Cox proportional hazard regression to compute hazard ratios (HRs) for 1-year mortality adjusted for potential confounding factors. Within 1 year, 17.1% of the patients died and the adjusted HRs ranged from 0.61 [95% confidence interval (CI) 0.55-0.67] for patient education to 0.99 (95% CI 0.90-1.10) for beta blocker therapy. The association between meeting more performance measures and 1-year mortality appeared to follow a dose-response pattern: using 0-25% of fulfilled measures as reference, patients who fulfilled 76-100% of the performance measures had an adjusted HR of 0.43 (95% CI 0.38-0.48), while the adjusted HR was 0.96 (95% CI 0.86-1.07) for patients who fulfilled between 26% and 50% of the performance measures. Conclusion: Meeting process performance measures, which reflect care in concordance with clinical guideline recommendations, was associated with substantially lower 1-year mortality among patients with incident HF.

LanguageEnglish
JournalEuropean Heart Journal - Quality of Care and Clinical Outcomes
Volume5
Issue number1
Pages28-34
ISSN2058-5225
DOIs
Publication statusPublished - 1 Jan 2019

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Process Assessment (Health Care)
Confidence Intervals
Guidelines
Patient Education
Physical Education and Training
Quality of Health Care
Angiotensin Receptor Antagonists
Hospital Departments
Denmark
Registries
Echocardiography
Inpatients
Outpatients
Outcome Assessment (Health Care)
Population

Cite this

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title = "Association between process performance measures and 1-year mortality among patients with incident heart failure: a Danish nationwide study",
abstract = "Aims: To examine the association between fulfilment of performance measures supported by clinical guidelines recommendations and 1-year mortality among patients with incident heart failure (HF) in Denmark. Methods and results: A nationwide population-based follow-up study based on the Danish Heart Failure Registry. All Danish hospital departments caring for patients with HF. We identified 24 308 in- and outpatients diagnosed with HF from 2003 to 2010. Quality of care was defined as receiving the guideline recommended processes of care: use of echocardiography, New York Heart Association classification, treatment with angiotensin-converting-enzyme inhibitors/angiotensin-II-receptor blocker, beta blockers, physical training, and patient education. Main outcome measure is 1-year mortality. We used multiple imputation and multivariable Cox proportional hazard regression to compute hazard ratios (HRs) for 1-year mortality adjusted for potential confounding factors. Within 1 year, 17.1{\%} of the patients died and the adjusted HRs ranged from 0.61 [95{\%} confidence interval (CI) 0.55-0.67] for patient education to 0.99 (95{\%} CI 0.90-1.10) for beta blocker therapy. The association between meeting more performance measures and 1-year mortality appeared to follow a dose-response pattern: using 0-25{\%} of fulfilled measures as reference, patients who fulfilled 76-100{\%} of the performance measures had an adjusted HR of 0.43 (95{\%} CI 0.38-0.48), while the adjusted HR was 0.96 (95{\%} CI 0.86-1.07) for patients who fulfilled between 26{\%} and 50{\%} of the performance measures. Conclusion: Meeting process performance measures, which reflect care in concordance with clinical guideline recommendations, was associated with substantially lower 1-year mortality among patients with incident HF.",
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Association between process performance measures and 1-year mortality among patients with incident heart failure : a Danish nationwide study. / Nakano, Anne; Vinter, Nicklas; Egstrup, Kenneth; Svendsen, Marie Louise; Schjødt, Inge; Johnsen, Søren Paaske.

In: European Heart Journal - Quality of Care and Clinical Outcomes, Vol. 5, No. 1, 01.01.2019, p. 28-34.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Association between process performance measures and 1-year mortality among patients with incident heart failure

T2 - European Heart Journal - Quality of Care and Clinical Outcomes

AU - Nakano, Anne

AU - Vinter, Nicklas

AU - Egstrup, Kenneth

AU - Svendsen, Marie Louise

AU - Schjødt, Inge

AU - Johnsen, Søren Paaske

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Aims: To examine the association between fulfilment of performance measures supported by clinical guidelines recommendations and 1-year mortality among patients with incident heart failure (HF) in Denmark. Methods and results: A nationwide population-based follow-up study based on the Danish Heart Failure Registry. All Danish hospital departments caring for patients with HF. We identified 24 308 in- and outpatients diagnosed with HF from 2003 to 2010. Quality of care was defined as receiving the guideline recommended processes of care: use of echocardiography, New York Heart Association classification, treatment with angiotensin-converting-enzyme inhibitors/angiotensin-II-receptor blocker, beta blockers, physical training, and patient education. Main outcome measure is 1-year mortality. We used multiple imputation and multivariable Cox proportional hazard regression to compute hazard ratios (HRs) for 1-year mortality adjusted for potential confounding factors. Within 1 year, 17.1% of the patients died and the adjusted HRs ranged from 0.61 [95% confidence interval (CI) 0.55-0.67] for patient education to 0.99 (95% CI 0.90-1.10) for beta blocker therapy. The association between meeting more performance measures and 1-year mortality appeared to follow a dose-response pattern: using 0-25% of fulfilled measures as reference, patients who fulfilled 76-100% of the performance measures had an adjusted HR of 0.43 (95% CI 0.38-0.48), while the adjusted HR was 0.96 (95% CI 0.86-1.07) for patients who fulfilled between 26% and 50% of the performance measures. Conclusion: Meeting process performance measures, which reflect care in concordance with clinical guideline recommendations, was associated with substantially lower 1-year mortality among patients with incident HF.

AB - Aims: To examine the association between fulfilment of performance measures supported by clinical guidelines recommendations and 1-year mortality among patients with incident heart failure (HF) in Denmark. Methods and results: A nationwide population-based follow-up study based on the Danish Heart Failure Registry. All Danish hospital departments caring for patients with HF. We identified 24 308 in- and outpatients diagnosed with HF from 2003 to 2010. Quality of care was defined as receiving the guideline recommended processes of care: use of echocardiography, New York Heart Association classification, treatment with angiotensin-converting-enzyme inhibitors/angiotensin-II-receptor blocker, beta blockers, physical training, and patient education. Main outcome measure is 1-year mortality. We used multiple imputation and multivariable Cox proportional hazard regression to compute hazard ratios (HRs) for 1-year mortality adjusted for potential confounding factors. Within 1 year, 17.1% of the patients died and the adjusted HRs ranged from 0.61 [95% confidence interval (CI) 0.55-0.67] for patient education to 0.99 (95% CI 0.90-1.10) for beta blocker therapy. The association between meeting more performance measures and 1-year mortality appeared to follow a dose-response pattern: using 0-25% of fulfilled measures as reference, patients who fulfilled 76-100% of the performance measures had an adjusted HR of 0.43 (95% CI 0.38-0.48), while the adjusted HR was 0.96 (95% CI 0.86-1.07) for patients who fulfilled between 26% and 50% of the performance measures. Conclusion: Meeting process performance measures, which reflect care in concordance with clinical guideline recommendations, was associated with substantially lower 1-year mortality among patients with incident HF.

U2 - 10.1093/ehjqcco/qcy041

DO - 10.1093/ehjqcco/qcy041

M3 - Journal article

VL - 5

SP - 28

EP - 34

JO - European Heart Journal - Quality of Care and Clinical Outcomes

JF - European Heart Journal - Quality of Care and Clinical Outcomes

SN - 2058-5225

IS - 1

ER -