Patient, hospital and country-level risk factors of all-cause mortality among patients with chronic heart failure: Prospective international cohort study.

<h4>Background</h4>Although many studies have described patient-level risk factors for outcomes in heart failure (HF), health care structural determinants remain largely unexplored. This research reports patient-, hospital- and country-level characteristics associated with 1-year all-cau...

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Autores principales:	Benedetta Pongiglione, Aleksandra Torbica, Chris P Gale, Luigi Tavazzi, Panos Vardas, Aldo P Maggioni
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/d0365f644b2a49ba9ce110f4f53e432e
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spelling	oai:doaj.org-article:d0365f644b2a49ba9ce110f4f53e432e2021-12-02T20:11:24ZPatient, hospital and country-level risk factors of all-cause mortality among patients with chronic heart failure: Prospective international cohort study.1932-620310.1371/journal.pone.0250931https://doaj.org/article/d0365f644b2a49ba9ce110f4f53e432e2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0250931https://doaj.org/toc/1932-6203<h4>Background</h4>Although many studies have described patient-level risk factors for outcomes in heart failure (HF), health care structural determinants remain largely unexplored. This research reports patient-, hospital- and country-level characteristics associated with 1-year all-cause mortality among patients with chronic HF, and investigates geographic and hospital variation in mortality.<h4>Methods and findings</h4>We included 9,277 patients with chronic HF enrolled between May 2011 and November 2017 in the prospective cohort study European Society of Cardiology Heart Failure Long Term registry across 142 hospitals, located in 22 countries. Mean age of the selected outpatients was 65 years (sd 13.2) and 28% were female. The all-cause 1-year mortality rate per 100 person-years was 7.1 (95% confidence interval (CI) 6.6-7.7), and varied between countries (median 6.8, IQR 5.6-11.2) and hospitals (median 7.8, IQR 5.2-12.4). Mortality was associated with age (incidence rate ratio 1.03, 95% CI 1.02-1.04), diabetes mellitus (1.37, 1.15-1.63), peripheral artery disease (1.56, 1.27-1.92), New York Heart Association class III/IV (1.91, 1.60-2.30), treatment with angiotensin-converting enzyme inhibitor and angiotensin receptor antagonists (0.71, 0.57-0.87) and HF clinic (0.64, 0.46-0.89). No other hospital-level characteristics, and no country-level healthcare characteristics were associated with 1-year mortality, with case-mix standardised variance between countries being very low (1.83e-06) and higher for hospitals (0.372).<h4>Conclusions</h4>All-cause mortality at 1 year among outpatients with chronic HF varies between countries and hospitals, and is associated with patient characteristics and the availability of hospital HF clinics. After full adjustment for clinical, hospital and country variables, between-country variance was negligible while between-hospital variance was evident.Benedetta PongiglioneAleksandra TorbicaChris P GaleLuigi TavazziPanos VardasAldo P MaggioniPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 5, p e0250931 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Benedetta Pongiglione Aleksandra Torbica Chris P Gale Luigi Tavazzi Panos Vardas Aldo P Maggioni Patient, hospital and country-level risk factors of all-cause mortality among patients with chronic heart failure: Prospective international cohort study.
description	<h4>Background</h4>Although many studies have described patient-level risk factors for outcomes in heart failure (HF), health care structural determinants remain largely unexplored. This research reports patient-, hospital- and country-level characteristics associated with 1-year all-cause mortality among patients with chronic HF, and investigates geographic and hospital variation in mortality.<h4>Methods and findings</h4>We included 9,277 patients with chronic HF enrolled between May 2011 and November 2017 in the prospective cohort study European Society of Cardiology Heart Failure Long Term registry across 142 hospitals, located in 22 countries. Mean age of the selected outpatients was 65 years (sd 13.2) and 28% were female. The all-cause 1-year mortality rate per 100 person-years was 7.1 (95% confidence interval (CI) 6.6-7.7), and varied between countries (median 6.8, IQR 5.6-11.2) and hospitals (median 7.8, IQR 5.2-12.4). Mortality was associated with age (incidence rate ratio 1.03, 95% CI 1.02-1.04), diabetes mellitus (1.37, 1.15-1.63), peripheral artery disease (1.56, 1.27-1.92), New York Heart Association class III/IV (1.91, 1.60-2.30), treatment with angiotensin-converting enzyme inhibitor and angiotensin receptor antagonists (0.71, 0.57-0.87) and HF clinic (0.64, 0.46-0.89). No other hospital-level characteristics, and no country-level healthcare characteristics were associated with 1-year mortality, with case-mix standardised variance between countries being very low (1.83e-06) and higher for hospitals (0.372).<h4>Conclusions</h4>All-cause mortality at 1 year among outpatients with chronic HF varies between countries and hospitals, and is associated with patient characteristics and the availability of hospital HF clinics. After full adjustment for clinical, hospital and country variables, between-country variance was negligible while between-hospital variance was evident.
format	article
author	Benedetta Pongiglione Aleksandra Torbica Chris P Gale Luigi Tavazzi Panos Vardas Aldo P Maggioni
author_facet	Benedetta Pongiglione Aleksandra Torbica Chris P Gale Luigi Tavazzi Panos Vardas Aldo P Maggioni
author_sort	Benedetta Pongiglione
title	Patient, hospital and country-level risk factors of all-cause mortality among patients with chronic heart failure: Prospective international cohort study.
title_short	Patient, hospital and country-level risk factors of all-cause mortality among patients with chronic heart failure: Prospective international cohort study.
title_full	Patient, hospital and country-level risk factors of all-cause mortality among patients with chronic heart failure: Prospective international cohort study.
title_fullStr	Patient, hospital and country-level risk factors of all-cause mortality among patients with chronic heart failure: Prospective international cohort study.
title_full_unstemmed	Patient, hospital and country-level risk factors of all-cause mortality among patients with chronic heart failure: Prospective international cohort study.
title_sort	patient, hospital and country-level risk factors of all-cause mortality among patients with chronic heart failure: prospective international cohort study.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/d0365f644b2a49ba9ce110f4f53e432e
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Patient, hospital and country-level risk factors of all-cause mortality among patients with chronic heart failure: Prospective international cohort study.

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