Study Says Treatment Guidelines, Not Patient Volume, May Be Most Important For Heart-Failure Care

It’s long been conventional wisdom in the healthcare community that patient volume at a hospital correlates with the hospital’s quality of care. For example, annual volumes for both heart failure and heart attacks are important components of the quality index used by U.S. News & World Report to rate cardiology programs for its annual “Best Hospitals” rankings.

However, a new study whose lead author is an assistant professor at UT Southwestern Medical Center indicates that, when it comes to heart failure, conventional wisdom about patient volume may not always be the case. According to the study published Monday in Circulation, a scientific journal, there’s only a very small, incremental relationship between how many heart-failure patients a hospital sees and the actual patient outcome. (Heart failure, which results when damage to the heart leaves it unable to pump enough blood, is said to affect about 6.5 million Americans.)

The new study, whose first author was Dr. Dharam Kumbhani, an interventional cardiologist at UT Southwestern Medical Center, showed that, among small and large treatment centers adhering to American Heart Association treatment guidelines for heart failure, early results were indistinguishable, and there were only modest differences in patient mortality or the need for hospital re-admission later on.

The researchers found that in comparing hospitals that treated fewer heart failure patients with those that treated more, smaller hospitals were significantly less likely to follow the AHA treatment guidelines. Their conclusion: adhering to treatment guidelines may be more important for quality than the volume of patients treated. That’s why it’s important, Kumbhani said, that more hospitals be given easy access to the treatment guidelines, as well as the means and ways to follow them.

Kumbhani, who’s a consultant for biotech firm Somahlution, was joined in the study by researchers (including consultants for various medical and pharmaceutical companies) from the likes of UCLA, Stanford University School of Medicine, Duke University Medical Center, and Harvard Medical School. The research was based on records for more than 125,000 heart-failure patients admitted between January 2005 and December 2014 to 342 U.S. hospitals.

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