Admission to hospitals with high 30-day risk-standardized mortality rates was associated with higher 5-year mortality compared to low-rate hospitals (76.8% vs 73.7%; HR 1.14, 95% CI 1.10-1.18).
Observational (n=106,304)
Yes
Does admission to hospitals with lower 30-day risk-standardized mortality rates improve long-term survival in patients hospitalized with heart failure?
Lower hospital-level 30-day risk-standardized mortality rates are associated with improved long-term survival up to 5 years in heart failure patients, validating its use as a meaningful performance metric.
Effect estimate: HR 1.14 (95% CI 1.10-1.18)
Absolute Event Rate: 76.8% vs 73.7%
Importance: Among patients hospitalized with heart failure (HF), the long-term clinical implications of hospitalization at hospitals based on 30-day risk-standardized mortality rates (RSMRs) is not known. Objective: To evaluate the association of hospital-specific 30-day RSMR with long-term survival among patients hospitalized with HF in the American Heart Association Get With The Guidelines-HF registry. Design, Setting, and Participants: The longitudinal observational study included 106 304 patients with HF who were admitted to 317 centers participating in the Get With The Guidelines-HF registry from January 1, 2005, to December 31, 2013, and had Medicare-linked follow-up data. Hospital-specific 30-day RSMR was calculated using a hierarchical logistic regression model. In the model, 30-day mortality rate was a binary outcome, patient baseline characteristics were included as covariates, and the hospitals were treated as random effects. The association of 30-day RSMR-based hospital groups (low to high 30-day RSMR: quartile 1 Q1 to Q4) with long-term (1-year, 3-year, and 5-year) mortality was assessed using adjusted Cox models. Data analysis took place from June 29, 2017, to February 19, 2018. Exposures: Thirty-day RSMR for participating hospitals. Main Outcomes and Measures: One-year, 3-year, and 5-year mortality rates. Results: Of the 106 304 patients included in the analysis, 57 552 (54.1%) were women and 84 595 (79.6%) were white, and the median (interquartile range) age was 81 (74-87) years. The 30-day RSMR ranged from 8.6% (Q1) to 10.7% (Q4). Hospitals in the low 30-day RSMR group had greater availability of advanced HF therapies, cardiac surgery, and percutaneous coronary interventions. In the primary landmarked analyses among 30-day survivors, there was a graded inverse association between 30-day RSMR and long-term mortality (Q1 vs Q4: 5-year mortality, 73.7% vs 76.8%). In adjusted analysis, patients admitted to hospitals in the high 30-day RSMR group had 14% (95% CI, 10-18) higher relative hazards of 5-year mortality compared with those admitted to hospitals in the low 30-day RSMR group. Similar findings were observed in analyses of survival from admission, with 22% (95% CI, 18-26) higher relative hazards of 5-year mortality for patients admitted to Q4 vs Q1 hospitals. Conclusions and Relevance: Lower hospital-level 30-day RSMR is associated with greater 1-year, 3-year, and 5-year survival for patients with HF. These differences in 30-day survival continued to accrue beyond 30 days and persisted long term, suggesting that 30-day RSMR may be a useful HF performance metric to incentivize quality care and improve long-term outcomes.
Pandey et al. (Mon,) conducted a observational in Heart Failure (n=106,304). High 30-day risk-standardized mortality rate (RSMR) hospitals (Q4) vs. Low 30-day RSMR hospitals (Q1) was evaluated on 5-year mortality among 30-day survivors (HR 1.14, 95% CI 1.10-1.18). Admission to hospitals with high 30-day risk-standardized mortality rates was associated with higher 5-year mortality compared to low-rate hospitals (76.8% vs 73.7%; HR 1.14, 95% CI 1.10-1.18).