A majority of heart failure (HF) related mortality occurred in patients who opted for a do not resuscitate (DNR) status with end-stage HF, thus limiting the appropriateness of administering evidence-based therapies. This according to a recent study that evaluated the Centers for Medicare and Medicaid Services’ (CMS) 30-day risk-adjusted mortality model and concluded that it fails to take important variables into consideration as an appropriate metric for quality. Electronic records were searched for patients with a diagnosis of HF who died from any cause during hospitalization or within 30-days of admission at a single institution. Researchers found:
- There were 646 HF-related admissions among 530 patients (1.2 admissions/patient).
- 67 of 530 (13%) patients died: 35 (52%) during hospitalization and 32 (48%) after discharge but within 30 days of admission.
- 51 (76%) patients died from HF and 16 (24%) from other causes.
- 55 (82%) patients were classified as AHA Stage-D, 58 (87%) as NYHA Class-IV, and 30 (45%) had right-ventricular systolic dysfunction.
- 57(85%) patients had a DNR status.
- No care gaps were identified that contributed to mortality.
Faillace RT, Yost GW, Chugh Y, et al. Is 30-day mortality after admission for heart failure an appropriate metric for quality? [Published online ahead of print September 20, 2017]. Am J Med. doi:10.1016/j.amjmed.2017.09.007.
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