DALLAS, Oct. 13, 2009 – Research has found broad differences between hospitals in the amount of resources used to treat elderly heart failure patients based on analyses of care during the last six months of life. This method of analysis has been used to rate hospitals on how efficiently they provide care. However, a new study says that looking only at the costs of treatment for patients who died ignores important differences between hospitals — such as survival rates — and overlooks potential associations between more resource use and better survival rates.

The study is in today’s Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.

Researchers analyzed 3,999 people, average age 80, hospitalized with a principal diagnosis of heart failure at six California teaching hospitals between Jan. 1, 2001 and June 30, 2005. They assessed total hospital days, total hospital direct costs, and death within 180-days after initial admission (called the “Looking Forward” method).

A subset of 1,639 individuals, average age 82, who died during the study period was analyzed for total hospital days and total hospital direct costs within 180 days before death (“Looking Back”).

• This study found variation among California teaching hospitals in survival for patients hospitalized with heart failure. This variation would have been overlooked by a “Looking Back” study that only examined heart failure patients who died.
• Analyzing all patients hospitalized for heart failure showed that California teaching hospitals that used more resources (financial, personnel, etc.) had lower death rates.
• Analyzing all patients hospitalized for heart failure showed that when “Looking Forward” the variation in resource use among California teaching hospitals was 27 percent to 44 percent less than the variation observed when “Looking Back” (analyzing only heart failure patients who died).

The researchers conclude that focusing only on patients who died may overlook important associations. The Looking Back method “ignores the possibility that resource-intensive care may improve survival, and therefore identifies resource-intensive care as inherently inefficient,” they said in the manuscript.

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.americanheart.org/corporatefunding.

NR09-1127 (Circ Outcomes/Ong)