ESC Heart Failure (Apr 2021)

Healthcare quality and mortality among patients hospitalized for heart failure by hospital level in Beijing, China

  • Liu He,
  • Zhao‐Jie Dong,
  • Xin Du,
  • Chao Jiang,
  • Ning Chen,
  • Shi‐Jun Xia,
  • Xiao‐Xia Hou,
  • Hai‐Rong Yu,
  • Qiang Lv,
  • Rong‐Hui Yu,
  • De‐Yong Long,
  • Rong Bai,
  • Nian Liu,
  • Cai‐Hua Sang,
  • Chen‐Xi Jiang,
  • Song‐Nan Li,
  • Mark D. Huffman,
  • Jian‐Zeng Dong,
  • Chang‐Sheng Ma

DOI
https://doi.org/10.1002/ehf2.13178
Journal volume & issue
Vol. 8, no. 2
pp. 1186 – 1194

Abstract

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Abstract Aims This study sought to compare healthcare quality and 30 day, 90 day, and 1 year mortality rates among patients admitted to secondary and tertiary hospitals for heart failure (HF) in Beijing. Methods and results This study retrospectively enrolled patients hospitalized with a primary discharge diagnosis of HF during January 2014 to December 2015, from five tertiary and four secondary hospitals, in Beijing, China. Mortality data were extracted from Beijing Death Surveillance Database. HF healthcare quality indices were used to evaluate in‐hospital care. Associations between hospital level and mortality rates were assessed using generalized linear mixed models, adjusting for patients' baseline characteristics and intra‐hospital correlation. Data from 1413 patients (median [interquartile range] age = 74 [65–80] years, 52.7% female) from secondary hospitals and 1250 patients (median [interquartile range] age = 72 [61–79] years, 43.3% female) from tertiary hospitals were collected. Rates of left ventricular ejection fraction assessment (73.2% vs. 90.1%) and combined use of β‐blockers and angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers (30.1% vs. 49.3%) were lower in secondary hospitals than those in tertiary hospitals, respectively. Patients admitted to secondary hospitals had a higher 90 day mortality [10.8% vs. 5.0%; adjusted odds ratio (OR): 2.06; 95% confidence interval (CI): 1.10–3.84, P = 0.024 and a higher 1 year mortality rate [21.0% vs. 12.1%; adjusted OR: 1.64; 95% CI: 1.02–2.62, P = 0.039], but 30 day mortality rates were not significantly different (5.5% vs. 3.0%; adjusted OR: 1.49; 95% CI: 0.63–3.52, P = 0.368). Conclusions Worse quality of care for patients with HF in secondary hospitals was associated with higher 90 day and 1 year mortality rates. Improving care quality in secondary hospitals is crucial to improve prognosis of patients they served.

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