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Improving the quality of heart failure care: secular trends at a regional center of excellence
Topic : cardiovascular nursing and allied professions
Sub-topic : Chronic Nursing Care
Session type : Rapid Fire Abstracts
Authors : S Stoerk (Wurzburg,DE), M Ertl (Wurzburg,DE), G Dietrich (Wurzburg,DE), M Kaspar (Wurzburg,DE), G Gueder (Wurzburg,DE), S Brenner (Wurzburg,DE), B Kraus (Wurzburg,DE), CE Angermann (Wurzburg,DE), G Ertl (Wurzburg,DE), F Puppe (Wuerzburg,DE)
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1University of Wurzburg - Wurzburg - Germany
2Chair Informatics VI - Wuerzburg - Germany
European Journal of Heart Failure Abstracts Supplement
Background: Heart failure (HF)
is the leading cause of hospitalization and a major cause of death in Germany. Cardiac societies, health policy makers and funding agencies strive to design and implement appropriate means to improve the quality of HF care, but quality control of such efforts has rarely been attempted. The University Hospital of Würzburg has a long research track in HF management. E.g., in 2003, a large multicentre intervention trial was started, revealing major positive effects of a dedicated HF management program executed by dedicated HF nurses (Circ Heart Fail. 2012;5:25-35). In Nov 2010, the Comprehensive Heart Failure Center (CHFC), sponsored by the Federal Ministry for Education and Research, was founded as an Integrated Center for Research and Treatment serving the aim to improve “Prevention of Heart Failure and its Complications”. Since then, the CHFC has implemented several tools which allow to assess the quality of intra- and extra-hospital HF care and to analyse in detail clinical outcomes over time. Methods: A dedicated data warehouse system was installed allowing reliable estimation of the true number of HF patients and their characteristics treated at the Center. The data warehouse exploits multiple information sources from standard clinical reports including the International Classification of Diseases (ICD) coded discharge diagnoses. We here analyse subjects with either of the 2 principal HF diagnoses I50 (“heart failure”) and I11.0 (“hypertensive heart disease with heart failure”) from years 2003 to 2014. Each subject was counted only once per year regardless of rehospitalization frequency. Results: We observed a pronounced increase in the absolute number of HF in- and out-patients attending the Medical Department of the University Hospital in the reported period for both principal HF diagnoses (Figure); in 2003: n = 52 (I11.0), and n = 699 (I50); in 2014: n = 780 (I11.0), and n = 2508 (I50). The proportion of women remained fairly stable over time at about 40% (45-50% for I11.0, and about 40% for I50, respectively). The proportion of patients aged > 65 years continuously dropped from about 82% in 2003 to 74% in 2014, while the proportion of patients aged > 79 years remained fairly constant about 30% over time. In the same period, median hospital-length of stay in HF patients decreased from 10 days to 7 days, and in-house mortality decreased from 15% in 2003 to 6% in 2012 and 5% in 2014 (Figure). Conclusions: The deliberate implementation of research and care structures was paralleled by major changes in patient populations treated at our tertiary care center. Improved awareness facilitating more adequate diagnostic coding is likely to affect mortality percentages (in particular in years 2013/2014). Improved measures for intra-hospital care and discharge management seem to help diagnosing HF earlier, attract more patients, and are associated with improved quality indicators.
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