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Association between enrolment in a heart failure quality registry and subsequent mortality—a nationwide cohort study
Author(s) -
Lund Lars H.,
Carrero JuanJesus,
Farahmand Bahman,
Henriksson Karin M.,
Jonsson Åsa,
Jernberg Tomas,
Dahlström Ulf
Publication year - 2017
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.762
Subject(s) - medicine , interquartile range , heart failure , hazard ratio , proportional hazards model , logistic regression , cohort , emergency medicine , cohort study , confidence interval
Aims Heart failure ( HF ) quality registries report quality of care but it is unknown whether they improve outcomes. The aims were to assess predictors of enrolment in a HF registry, test the hypothesis that enrolment in a HF registry is associated with reduced mortality, and assess potential explanatory factors for this reduction in mortality, if present. Methods and results We conducted a nationwide prospective cohort study of patients with new‐onset HF registered in the Swedish National Patient Registry ( NPR , a mandatory registry of ICD ‐code diagnoses) with or without concurrent registration in the Swedish Heart Failure Registry ( SwedeHF , a voluntary quality reporting registry) 2006–2013. The association between demographics, co‐morbidities and medications, and enrolment in the SwedeHF , was assessed using multivariable logistic regression. The association between enrolment in the SwedeHF and all‐cause mortality was assessed using multivariable Cox regression, with adjustment for demographics, co‐morbidities and medications. A total of 231 437 patients were included, of which 21 888 (9.5%) were in the SwedeHF [age (mean ± standard deviation) 74 ± 13 years; 41% women; 68% inpatients] and 209 549 (90.5%) were not (age 78 ± 12 years, 50% women; 79% inpatients). Selected variables independently associated with enrolment in the SwedeHF were male sex, younger age, higher education, absent co‐morbidities and co‐morbidity‐related medications, and use of HF and cardiovascular medications. Over a median (interquartile range) follow‐up of 874 (247–1667) days, there were 13.0 vs. 20.8 deaths per 100 patient‐years ( P < 0.001). The hazard ratio (95% confidence interval) for death for the SwedeHF yes vs. no was 0.65 (0.63–0.66) crude, and increased to 0.80 (0.78–0.81) after adding demographics, to 0.82 (0.80–0.84) after adding co‐morbidities and co‐morbidity‐related medications, to 0.95 (0.93–0.97) after adding cardiovascular medications, and to 1.04 (1.02–1.07) after adding HF ‐specific medications. Conclusion Heart failure patients of male sex, younger age, and higher education were more likely to be enrolled in a HF quality registry. Enrolment was associated with reduced all‐cause mortality that was explained by demographic differences and better utilization of cardiovascular and HF medications.