Substantial between-hospital variation in outcome following first emergency admission for heart failure

Abstract

A patient admitted to one Scottish hospital with heart failure may be two to three times more likely to die or be readmitted, both in the short and longer term, compared to a patient admitted to another hospital. Although we may not have accounted for some sources of variation, it is both surprising and disturbing that large, statistically significant, differences in adjusted death and readmission rates can apparently exist for such an important condition in a relatively small country with generally homogenous health care provision. Further, detailed investigation of this apparent variation is required.

I Diretriz Latino-Americana para avaliação e conduta na insuficiência cardíaca descompensada

“…In Brazil, in-hospital mortality due to HF in SUS hospitals (Brazilian Public Health System) varied between 5.6%-6,0% in the last 3 years (Table 1). International data show a great variation among different types of institutions in the rates of in-hospital deaths (between 8.5% and 23.1%) 11 , which is possibly due to substantial differences in the clinical characteristics and treatments in each population studied. Some data also demonstrate a time trend in the reduction of in-hospital mortality 12 .…”

Assessing the impact of heart failure specialist services on patient populations

“…In Scotland, during the period 1990–1995, the mean number of admissions independently of discharge status (dead or alive) was 341 in large teaching hospitals and 244 in large general hospitals -possibly of similar type to Stockport NHS Trust [42]. Therefore the number of patients modelled in our study is of the expected order compared to the literature.…”

“…Therefore the number of patients modelled in our study is of the expected order compared to the literature. We have opted to use data relating to patients with "primary" diagnosis of heart failure, as nationally in the UK and in the literature [2,3,8,15,41,42], the use of primary diagnosis is well-established for estimates of heart failure disease burden, and local policy makers will be familiar with such use of the data. We have however addressed the potential for under-estimation of true disease burden, and, subsequently, the potential underestimation of the impact of modelled interventions through sensitivity analysis.…”

Variability in use of IV nitrates and diuretics in acute HF: a ‘virtual patient’ clinical decision-making study

“…117 In England and Wales, the National Heart Failure Audit revealed considerable differences across hospitals in a number of areas of heart failure care, including the proportions of patients undergoing key diagnostic tests, receiving cardiovascular medications on discharge and being referred to cardiology follow-up services. Wide variations in hospital performance in acute heart failure have been reported 119,120 Differences in patient outcomes and the use of healthcare resources also illustrate variations in heart failure care among hospitals and across regions. Significant regional differences in outcomes were seen for patients hospitalized for acute heart failure in Canada, with readmission rates and in-hospital death rates varying across provinces (Figure 4.4).…”

“…Substantial differences in death and 30-day rehospitalization rates were also seen among hospitals in Scotland for patients following their first hospitalization for acute heart failure. 120 Analysis of six teaching hospitals in California, USA, revealed wide variations in death rates across the sites for patients with heart failure, with 180-day rates ranging from 17.0% to 26.0% (when adjusted for differences in patient characteristics between hospitals). 121 Days spent in hospital and treatment costs also varied considerably over the 180-day period after initial hospitalization, with a two-fold difference in the number of hospital days reported across sites.…”