Healthcare quality and mortality among patients hospitalized for heart failure by hospital level in Beijing, China

Liu He, Zhao Jie Dong, Xin Du*, Chao Jiang, Ning Chen, Shi Jun Xia, Xiao Xia Hou, Hai Rong Yu, Qiang Lv, Rong Hui Yu, De Yong Long, Rong Bai, Nian Liu, Cai Hua Sang, Chen Xi Jiang, Song Nan Li, Mark D. Huffman, Jian Zeng Dong, Chang Sheng Ma

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Aims: This study sought to compare healthcare quality and 30 day, 90 day, and 1 year mortality rates among patients admitted to secondary and tertiary hospitals for heart failure (HF) in Beijing. Methods and results: This study retrospectively enrolled patients hospitalized with a primary discharge diagnosis of HF during January 2014 to December 2015, from five tertiary and four secondary hospitals, in Beijing, China. Mortality data were extracted from Beijing Death Surveillance Database. HF healthcare quality indices were used to evaluate in-hospital care. Associations between hospital level and mortality rates were assessed using generalized linear mixed models, adjusting for patients' baseline characteristics and intra-hospital correlation. Data from 1413 patients (median [interquartile range] age = 74 [65–80] years, 52.7% female) from secondary hospitals and 1250 patients (median [interquartile range] age = 72 [61–79] years, 43.3% female) from tertiary hospitals were collected. Rates of left ventricular ejection fraction assessment (73.2% vs. 90.1%) and combined use of β-blockers and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (30.1% vs. 49.3%) were lower in secondary hospitals than those in tertiary hospitals, respectively. Patients admitted to secondary hospitals had a higher 90 day mortality [10.8% vs. 5.0%; adjusted odds ratio (OR): 2.06; 95% confidence interval (CI): 1.10–3.84, P = 0.024 and a higher 1 year mortality rate [21.0% vs. 12.1%; adjusted OR: 1.64; 95% CI: 1.02–2.62, P = 0.039], but 30 day mortality rates were not significantly different (5.5% vs. 3.0%; adjusted OR: 1.49; 95% CI: 0.63–3.52, P = 0.368). Conclusions: Worse quality of care for patients with HF in secondary hospitals was associated with higher 90 day and 1 year mortality rates. Improving care quality in secondary hospitals is crucial to improve prognosis of patients they served.

Original languageEnglish (US)
Pages (from-to)1186-1194
Number of pages9
JournalESC Heart Failure
Issue number2
StatePublished - Apr 2021


  • China
  • Healthcare quality
  • Heart failure
  • Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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