Quality of Care for Patients Hospitalized for Heart Failure in China

This cross-sectional study examines the quality of care provided by hospitals to patients with heart failure in China by assessing hospitals' adherence to 4 core performance measures for inpatient care of heart failure. Key PointsQuestionWhat is the quality of care provided by hospitals in China to patients with heart failure in terms of adherence to 4 core performance measures for inpatient heart failure care? FindingsIn this cross-sectional analysis of hospital records in China from 2015, which included 10004 hospitalizations from 189 hospitals, the median composite performance score across all hospitals for the 4 core performance measures was 40.0%. The odds of receiving guideline-recommended care varied, on average, by 2- to 5-fold among hospitals for the core measures. MeaningThe findings of this study suggest that the quality of care in China for patients with heart failure may be substandard and that there may be wide heterogeneity in the quality of care for these patients among hospitals in China. ImportanceGiven the emerging heart failure (HF) epidemic in China, monitoring and improving the quality of care for heart failure is a top priority. ObjectivesTo assess the quality of HF care provided to inpatients by examining the adherence to quality measures for HF care at the hospital level and to identify factors associated with the quality of care. Design, Setting, and ParticipantsIn this multicenter, hospital-based, retrospective cross-sectional study in China, medical records of patients hospitalized for HF from January 1, 2015, to December 31, 2015, were analyzed from January 1, 2018, to May 20, 2019. In the first stage, simple random sampling stratified by economic-geographical regions in China was used to generate a list of participating hospitals. In the second stage, 15538 hospitalizations from the 189 selected hospitals were systematically sampled, and 10004 HF hospitalizations were included in the final sample. Main Outcomes and MeasuresAdherence to the following 4 core performance measures at the hospital level: (1) left ventricular ejection fraction assessment during hospitalization; (2) evidence-based beta -blocker (bisoprolol, carvedilol, or metoprolol succinate) for eligible patients at discharge; (3) angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for eligible patients at discharge; and (4) scheduled follow-up appointment at discharge. At the hospital level, a composite performance score (ranging from 0-1) was also calculated by averaging these measures. ResultsIn total, 10 004 hospital admissions for HF at 189 hospitals were included in this study. The median (interquartile range [IQR]) patient age at admission was 73 (65-80) years, and 5117 (51.1%) of the patients were men. Among all hospitals, the median rate of adherence to measure 1 was 66.7% (IQR, 45.5%-80.7%; range, 0%-100%). The rate for adherence to measure 2 was 14.8% (IQR, 0%-37.5%; range, 0%-81.8%), and the rate for measure 3 was 57.1% (IQR, 36.4%-75.0%; range, 0%-100%). For measure 4, the median rate of adherence was 11.5% (IQR, 3.3%-32.8%; range, 0%-96.7%). The median (IQR) composite performance score across all hospitals was 40.0% (26.9%-51.9%), with a range from 2.2% to 85.4%. The median odds ratios of adherence were 2.2 (95% CI, 2.0-2.4) for measure 1, 2.1 (95% CI, 1.8-2.4) for measure 2, 2.4 (95% CI, 2.0-2.9 for measure 3, and 4.8 (95% CI, 3.9-5.8) for measure 4 among hospitals. Conclusions and RelevanceThe findings of this study suggest that quality of care for patients with HF in China may be substandard, and there is wide heterogeneity in the quality of care for HF among hospitals. The findings also suggest the need for a national strategy to improve and standardize the quality of HF care in China.