Regulatory Relationships of Demographic, Clinical Characteristics and Quality of Care for Heart Failure Patients in Southern China

Author(s):  
Rong Fu ◽  
Shaodan Feng ◽  
Qidong Chen ◽  
Yulan Lin ◽  
Zheng Lin ◽  
...  

Abstract Background Quality of care for Chinese patients with heart failure was substandard. It is of utmost value to ascertain the characteristics related to quality of care to narrow the gap. Methods Data from 2,064 heart failure patients between 1 January 2012 and 31 December 2015 at a hospital in Fujian Province were analyzed. Bayesian Network was used to assess the regulatory relationships between demographic, clinical characteristics and compliance with quality indicators. Results The compliance with quality indicators ranged from 42.5% to 90.2%. The compliance with recommended doses for medications all reached or was close to 100% except indapamide. In Bayesian network, residence place, hypertension, troponin, B-type natriuretic peptide, heart rate, lung disease, number of emergency treatment, ejection fraction directly regulated the compliance and gender, age, medical payment method, myocardiopathy, coronary heart disease, arrhythmia had indirectly effect. The lower compliance was found in patients under emergency treatment, patients with abnormal testing indicators, patients without specific comorbidities and patients with NRCMS or self-paying. Patients with lung disease and those who lived in urban area had longer length of stay. Conclusions The compliance with medication indicators for heart failure were suboptimal, but recommended doses were prescribed in patients who received medications. A series of strategies should be developed to improve the quality of care, such as expanding the scope and depth of knowledge of guidelines and clinical pathway, integrating the reminder and quality assessment model into hospital medical record information system, paying more attention to vulnerable population and improving the medical security system.

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Maira Tristao Parra ◽  
Meredith A Pung ◽  
Kathleen Wilson ◽  
Christopher Pruitt ◽  
Barry H Greenberg ◽  
...  

Hypothesis: insufficiently active heart failure patients will report poorer QoL, more fatigue and depressive mood compared to active patients. Aims: To characterize clinical characteristics and health-related behaviors according to physical activity (PA). Also, to explore predicting factors of quality of life (QoL). Methods: Cross-sectional analysis of a cohort of Stage B HF patients. PA classification was set as active, moderately active or insufficiently active, according to the LTEQ questionnaire. For QoL, the SF-36 questionnaire was used. ANOVAS, Chi-Square tests or likelihood ratios and unadjusted multiple regression models were calculated. Significance was set at p ≤ 0.05. Results: In this cohort, 277 HF patients completed the PA questionnaire. The prevalence of active patients was higher than moderately active and insufficiently active (53.3% vs 15.2% and 29.6%), respectively. Younger age (p = 0.044), lower waist circumference (WC) (p = 0.002), and lower waist-to-hip ratio (p = 0.046) were associated with being active. The prevalence of Type II diabetes mellitus (T2DM) in the active groups was significantly lower (p = 0.001). Physically active groups had cases of mild LV enlargement (1.4% and 7.5%, respectively), while no cases were observed among insufficiently active patients (p = 0.017). PA was positively associated with less fatigue (p= 0.002), more vigor (p = 0.001), more self-efficacy (p < 0.001), and better quality of life (p = 0.002). Patients who were less physically active had more inflammation (CRP, p = 0.015; IL-6, p <0.001; TNF-α: p = 0.033, and IL-1ra, p = 0.001). WC (β =-0.16, p = 0.008), glucose (β =-0.12, p < 0.001) and fatigue (β = - 0.39, p < 0.001) predicted general health perception (R 2 = 0.449). For physical functioning (high scores reflects performing PA without limitations due to health), WC (β = - 0.28, p = 0.001), sleep (β = - 1.50, p = 0.003) and fatigue (β = - 0.32, p = 0.018) were significant predictors (R 2 = 0.422); while age (β = 0.36, p <0.001) physical activity (β = 0.051, p = 0.055), sleep (β = 0.50, p =0.046), fatigue (β = -0.37, p <0.001) and depression (β = -1.12, p <0.001) predicted emotional well-being (R 2 = 0.696). Conclusion: Physically active heart failure patients had a better anthropometric profile and lower prevalence of T2DM. In this cohort, PA was not a significant predictor for general and physical functioning, but it remained relevant for predicting emotional well-being.


2014 ◽  
Vol 63 (2) ◽  
pp. 123-130 ◽  
Author(s):  
Saul Blecker ◽  
Sunil K. Agarwal ◽  
Patricia P. Chang ◽  
Wayne D. Rosamond ◽  
Donald E. Casey ◽  
...  

Circulation ◽  
2012 ◽  
Vol 125 (24) ◽  
pp. 2985-2992 ◽  
Author(s):  
Maurizio Landolina ◽  
Giovanni B. Perego ◽  
Maurizio Lunati ◽  
Antonio Curnis ◽  
Giuseppe Guenzati ◽  
...  

2020 ◽  
Vol 26 (10) ◽  
pp. S131-S132
Author(s):  
Theresa Diederich ◽  
Scott Lundgren ◽  
Bunny Pozehl ◽  
Kelly Ferguson ◽  
Kyana Holder ◽  
...  

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Afsaneh Roshanghalb ◽  
Cristina Mazzali ◽  
Emanuele Lettieri

Abstract Background This study aims at gathering evidence about the relation between 30-day mortality and 30-day unplanned readmission and patient and hospital factors. By definition, we refer to 30-day mortality and 30-day unplanned readmission as the number of deaths and non-programmed hospitalizations for any cause within 30 days after the incident heart failure (HF). In particular, the focus is on the role played by hospital-level factors. Methods A multi-level logistic model that combines patient- and hospital-level covariates has been developed to better disentangle the role played by the two groups of covariates. Later on, hospital outliers in term of better-than-expected/worst-than-expected performers have been identified by comparing expected cases vs. observed cases. Hospitals performance in terms of 30-day mortality and 30-day unplanned readmission rates have been visualized through the creation of funnel plots. Covariates have been selected coherently to past literature. Data comes from the hospital discharge forms for Heart Failure patients in the Lombardy Region (Northern Italy). Considering incident cases for HF in the timespan 2010–2012, 78,907 records for adult patients from 117 hospitals have been collected after quality checks. Results Our results show that 30-day mortality and 30-day unplanned readmissions are explained by hospital-level covariates, paving the way for the design and implementation of evidence-based improvement strategies. While the percentage of surgical DRG (OR = 1.001; CI (1.000–1.002)) and the hospital type of structure (Research hospitals vs. non-research public hospitals (OR = 0.62; CI (0.48–0.80)) and Non-research private hospitals vs. non-research hospitals OR = 0.75; CI (0.63–0.90)) are significant for mortality, the mean length of stay (OR = 0.96; CI (0.95–0.98)) is significant for unplanned readmission, showing that mortality and readmission rates might be improved through different strategies. Conclusion Our results confirm that hospital-level covariates do affect quality of care, and that 30-day mortality and 30-day unplanned readmission are affected by different managerial choices. This confirms that hospitals should be accountable for their “added value” to quality of care.


2018 ◽  
Vol Volume 11 ◽  
pp. 405-412 ◽  
Author(s):  
Shunsuke Kojima ◽  
Eiji Hiraoka ◽  
Junya Arai ◽  
Yosuke Homma ◽  
Yasuhiro Norisue ◽  
...  

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