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

Authors

Luke C Cunningham
Gregg C Fonarow
Clyde W Yancy
Shubin Sheng
Roland A Matsouaka
Adam D DeVore
Hani Jneid
Anita Deswal

Publication Date

4-6-2021

Journal

Journal of the American Heart Association

DOI

10.1161/JAHA.120.018696

PMID

33759546

PMCID

PMC8174327

PubMedCentral® Posted Date

3-24-2021

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Aged, Female, Guideline Adherence, Heart Failure, Humans, Inpatients, Male, Quality of Health Care, Registries, heart failure, quality and outcomes, regional variations

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.

Comments

Associated Data