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Quality of care and outcomes of older patients with heart failure hospitalized in the United States and Canada.
- Source :
-
Archives of internal medicine [Arch Intern Med] 2005 Nov 28; Vol. 165 (21), pp. 2486-92. - Publication Year :
- 2005
-
Abstract
- Background: Health care expenditure per person is significantly higher in the United States compared with Canada, but whether there are differences in quality of care of many conditions is unknown. We compared the process of care and outcomes of patients with heart failure, the most common cause of hospitalization for individuals 65 years and older in both countries.<br />Methods: We compared processes of care and 30-day and 1-year risk-standardized mortality rates among 28,521 US Medicare beneficiaries and 8180 similarly aged patients in Ontario, Canada, hospitalized with heart failure from 1998 to 2001.<br />Results: More US patients underwent left ventricular ejection fraction assessment during hospitalization compared with Canadian patients (61.2% vs 41.7%, P<.001). At discharge, patients in the United States were prescribed beta-blockers more frequently (28.7% vs 25.4%, P<.001) but angiotensin-converting enzyme inhibitors less frequently (54.3% vs 63.4%, P<.001). Among ideal candidates, prescription of beta-blockers (32.5% vs 29.7%, P = .08) or angiotensin-converting enzyme inhibitors (78.3% vs 77.6%, P = .68) was not significantly different between the 2 countries. The US patients had lower risk characteristics on admission and lower crude mortality rates at 30 days and 1 year. Thirty-day risk-standardized mortality was significantly lower for the US patients (8.9% vs 10.7%, P<.001), but 1-year risk-standardized mortality was no longer significantly different (32.2% vs 32.3%, P = .98).<br />Conclusion: Patients with heart failure who are hospitalized in the United States had lower short-term mortality at 30 days, but 1-year mortality rates were not significantly different between the United States and Canada.
- Subjects :
- Aged
Aged, 80 and over
Canada epidemiology
Female
Heart Failure mortality
Heart Failure physiopathology
Humans
Male
Prognosis
Retrospective Studies
Severity of Illness Index
Stroke Volume physiology
Survival Rate trends
United States epidemiology
Heart Failure therapy
Hospitalization statistics & numerical data
Inpatients
Outcome Assessment, Health Care
Quality Assurance, Health Care
Subjects
Details
- Language :
- English
- ISSN :
- 0003-9926
- Volume :
- 165
- Issue :
- 21
- Database :
- MEDLINE
- Journal :
- Archives of internal medicine
- Publication Type :
- Academic Journal
- Accession number :
- 16314545
- Full Text :
- https://doi.org/10.1001/archinte.165.21.2486