Regional Variations in Heart Failure Quality and Outcomes: Get With The Guidelines–Heart Failure Registry

Abstract

Background Regional patient characteristics, care quality, and outcomes may differ based on a variety of factors among patients hospitalized for heart failure (HF). Regional disparities in outcomes of cardiovascular disease have been suggested across various regions in the United States. This study examined whether there are significant differences by region in quality of care and short‐term outcomes of hospitalized patients with HF across the United States. Methods and Results We examined regional demographics, quality measures, and short‐term outcomes across 4 US Census Bureau regions in patients hospitalized with HF and enrolled in the GWTG‐HF (Get With The Guidelines–Heart Failure) registry from 2010 to 2016. Differences in length of stay and mortality by region were examined with multivariable logistic regression. The study included 423 333 patients hospitalized for HF in 488 hospitals. Patients in the Northeast were significantly older. Completion of achievement measures, with few exceptions, were met with similar frequency across regions. Multivariable analysis demonstrated significantly lower in‐hospital mortality in the Midwest compared with the Northeast (hazard ratio, 0.64; 95% CI, 0.51–0.8; P <0.00001). The length of stay varied significantly by region with a significantly higher risk‐adjusted length of stay in the Northeast compared with other regions. Conclusions Although we did not find any substantial differences by region in quality of care in patients hospitalized for HF, risk‐adjusted inpatient mortality was found to be lower in the Midwest compared with the Northeast, and may be secondary to unmeasured differences in patient characteristics, and to longer length of stay in the Northeast.

Patient profiles on outcomes in patients hospitalized for heart failure: a 10‐year history of the Malaysian population

“…23,27,28 The mean age (72.2 years) of patients in the GWTG-HF registry from the USA was higher by almost a decade than that observed in our study. 28 Comparable age was observed in all three local single-centre studies, including IJN ADHF registry, SGH-HF and UiTM Sungai Buloh (mean age of 62, 59 and 63, respectively). 24,25 These findings suggest that HF patients in Malaysia are relatively younger, which is not surprising.…”

“…23,27 However, a much higher proportion of females (48.2%) was observed in the GWTG-HF registry from the USA than was seen in our analysis. 28 Of the hospitalized HF patients in this study, 62.9% had reduced ejection fraction. A relatively lower proportion of HFrEF patients was reported in the SGH-HF (51%), UiTM Sungai Buloh (40.8%) and ADHERE-AP (53%) populations, indicating that half of the hospitalized HF patients had HFmrEF and HFpEF.…”

Relation of Household Income to Access and Adherence to Combination Sacubitril/Valsartan in Heart Failure: A Retrospective Analysis of Commercially Insured Patients

“…29 Geographic regionality may influence differences in health care utilization and practice patterns. [30][31][32] The potential for variations in the delivery of care has led to new clinical practice guidelines that describe ways that providers can increase value in the US health care system. 11,29 Renewed health policy models now evaluate health systems' payment structures to determine the effectiveness of therapies of HF outcomes and costs.…”

Quality indicators for acute cardiovascular diseases: a scoping review

“…QI sets are commonly developed through the following process: literature review, identification of domains, and selection of the final QI set through a consensus process such as the Delphi method [ 8 ]. Some studies have shown that an evidence-practice gap exists in real-world practice, such as early reperfusion in patients with ACS [ 9 , 10 ]. Furthermore, high attainment of the QI set has been associated with lower risk-adjusted mortality [ 9 , 10 ].…”

“…Some studies have shown that an evidence-practice gap exists in real-world practice, such as early reperfusion in patients with ACS [ 9 , 10 ]. Furthermore, high attainment of the QI set has been associated with lower risk-adjusted mortality [ 9 , 10 ]. Although many QI sets are related to acute cardiovascular diseases [ 11 , 12 ], a comprehensive summary is lacking.…”