Heart Failure Treatment Rates Similar For Most Hospitals
Non-ranked hospitals may be just as likely to provide quality care for heart failure patients as those ranked as the best in heart and heart surgery by the U. S. News & World Report, according to a new study published in Circulation: Cardiovascular Quality and Outcomes.
“Heart failure is the most common reason that people are admitted to the hospital for cardiovascular care,” said Harlan M. Krumholz, M.D., senior author of the study and professor of medicine and outcomes researcher at Yale University School of Medicine in New Haven, Conn. “We conducted this study to determine whether the annually reported U.S. News & World Report list provides information that is similar or different than hospital national performance measures published by the Centers for Medicare and Medicaid Services (CMS).”
Krumholz and colleagues compared heart failure mortality and readmission rates at 50 ranked hospitals on the U.S. News & World Report list to outcomes of heart failure patients at about 4,700 non-ranked U.S. hospitals using CMS’s 30-day outcomes report on heart failure.
Ranked hospitals, as a group, were more likely than non-ranked hospitals to have low 30-day mortality rates after heart failure, researchers said. Average 30-day heart failure mortality rates were 10.1 percent in ranked hospitals and 11.2 percent in non-ranked. However, the 30-day mortality rates varied widely for both ranked and non-ranked institutions, ranging from 7.9 percent to 12.4 percent for ranked hospitals and from 7.1 percent to 17.5 percent for non-ranked hospitals.
“With this list, you’re identifying a group that on average does better, but some that are not better than average,” Krumholz said. “But none of the hospitals on the U.S. News & World Report list had below average quality measures when it came to heart failure mortality.”
However, those on the best hospitals list didn’t fare as well on readmission rates.
Average 30-day heart failure readmission rates were no different between ranked and non-ranked hospitals in the study. The 30-day readmission rates ranged from 18.7 percent to 29.3 percent for ranked hospitals and from 19.2 percent to 29.8 percent for non-ranked hospitals.
The readmission rate is another indicator of quality of care and an important consideration for heart failure patients because one in four heart failure patients is readmitted to the hospital within 30 days of discharge, Krumholz said.
“The ways in which these hospitals are excelling in mortality do not seem to be transferring to excellence in transitioning people from being in the hospital to staying out of the hospital,” he said. “People referring to the list, for the most part, want to know about individual hospitals – not how hospitals have done as a group.
“The message from this study is that if you really want to know how a hospital compares in the areas of heart failure mortality and readmission, you should look directly at government statistics for those measures and not assume that only the hospitals on the list are the best in the care of heart failure patients.”
In fact, hospitals that aren’t routinely ranked and don’t have well-earned reputations can also achieve high quality of care, said Clyde W. Yancy, M.D. president of the American Heart Association and medical director at Baylor Heart and Vascular Institute in Dallas, Texas. “We believe hospitals that use proven quality improvement initiatives, such as the American Heart Association’s Get With The Guidelines program, which increases quality via adherence to evidence-based therapy, can achieve quality outcomes that rival any facility in the country.
Rest assured that it is definitely possible and highly likely that excellent quality care is attainable for any patient, in any facility, in any state and in any region of the country.”