National Trends in Hospital Performance in Guideline-Recommended Pharmacologic Treatment for Heart Failure at Discharge

被引：0

作者：

Hess, Paul L. ^{[1
,2
,6
]}

Langner, Paula ^{[1
,2
]}

Heidenreich, Paul A. ^{[3
,4
]}

Essien, Utibe ^{[5
]}

Leonard, Chelsea ^{[1
,2
]}

Swat, Stanley A. ^{[1
,2
]}

Polsinelli, Vincenzo ^{[1
,2
]}

Orlando, Steven T. ^{[2
]}

Grunwald, Gary K. ^{[1
,2
]}

Ho, Michael ^{[1
,2
]}

机构：

[1] Rocky Mt Reg VA Med Ctr, Aurora, CO USA

[2] Univ Colorado, Anschutz Med Campus, Aurora, CO USA

[3] Palo Alto VA Med Ctr, Palo Alto, CA USA

[4] Stanford Univ, Sch Med, Palo Alto, CA USA

[5] Greater Los Angeles VA Med Ctr, Los Angeles, CA USA

[6] Rocky Mt Reg VA Med Ctr, 1700 North Wheeling St, Aurora, CO 80045 USA

来源：

JACC-HEART FAILURE | 2024年 / 12卷 / 06期

基金：

美国国家卫生研究院;

关键词：

heart failure hospitalization; prescribing patterns; quality of care; HEALTH-CARE-SYSTEM; MEDICATION INITIATION; MORTALITY; WARFARIN;

D O I：

暂无

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND The use of recommended heart failure (HF) medications has improved over time, but opportunities for improvement persist among women and at rural hospitals. OBJECTIVES This study aims to characterize national trends in performance in the use of guideline -recommended pharmacologic treatment for HF at U.S. Department of Veterans Affairs (VA) hospitals, at which medication copayments are modest. METHODS Among patients discharged from VA hospitals with HF between January 1, 2013, and December 31, 2019, receipt of all guideline -recommended HF pharmacotherapy among eligible patients was assessed, consisting of evidencebased beta-blockers; angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor neprilysin inhibitors; mineralocorticoid receptor antagonists; and oral anticoagulation. RESULTS Of 55,560 patients at 122 hospitals, 32,304 (58.1%) received all guideline -recommended HF medications for which they were eligible. The proportion of patients receiving all recommended medications was higher in 2019 relative to 2013 (OR: 1.54; 95% CI: 1.44-1.65). The median of hospital performance was 59.1% (Q1 -Q3: 53.2%-66.2%), improving with substantial variation across sites from 2013 (median 56.4%; Q1 -Q3: 50.0%-62.0%) to 2019 (median 65.7%; Q1 -Q3: 56.3%-73.5%). Women were less likely to receive recommended therapies than men (adjusted OR [aOR]: 0.84; 95% CI: 0.74-0.96). Compared with non -Hispanic White patients, non -Hispanic Black patients were less likely to receive recommended therapies (aOR: 0.83; 95% CI: 0.79-0.87). Urban hospital location was associated with lower likelihood of medication receipt (aOR: 0.73; 95% CI: 0.59-0.92). CONCLUSIONS Forty-two percent of patients did not receive all recommended HF medications at discharge, particularly women, minority patients, and those receiving care at urban hospitals. Rates of use increased over time, with variation in performance across hospitals. (J Am Coll Cardiol HF 2024;12:1059 -1070) Published by Elsevier on behalf of the American College of Cardiology Foundation.

引用

页数：12

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