Regional variations in heart failure quality and outcomes: Get with the guidelines– heart failure registry

BACKGROUND: Regional patient characteristics, care quality, and outcomes may differ based on a variety of factors among patients hospitalized for heart failure (HF). Regional disparities in outcomes of cardiovascular disease have been suggested across various regions in the United States. This study examined whether there are significant differences by region in quality of care and short-term outcomes of hospitalized patients with HF across the United States. METHODS AND RESULTS: We examined regional demographics, quality measures, and short-term outcomes across 4 US Census Bureau regions in patients hospitalized with HF and enrolled in the GWTG-HF (Get With The Guidelines– Heart Failure) registry from 2010 to 2016. Differences in length of stay and mortality by region were examined with multivariable logistic regression. The study included 423 333 patients hospitalized for HF in 488 hospitals. Patients in the Northeast were significantly older. Completion of achievement measures, with few exceptions, were met with similar frequency across regions. Multivariable analysis demonstrated significantly lower in-hospital mortality in the Midwest compared with the Northeast (hazard ratio, 0.64; 95% CI, 0.51– 0.8; P<0.00001). The length of stay varied significantly by region with a significantly higher risk-adjusted length of stay in the Northeast compared with other regions. CONCLUSIONS: Although we did not find any substantial differences by region in quality of care in patients hospitalized for HF, risk-adjusted inpatient mortality was found to be lower in the Midwest compared with the Northeast, and may be secondary to unmeasured differences in patient characteristics, and to longer length of stay in the Northeast.