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Comparative Study
. 2014 May;7(3):427-33.
doi: 10.1161/CIRCHEARTFAILURE.113.000698. Epub 2014 Mar 14.

Hospital variation in noninvasive positive pressure ventilation for acute decompensated heart failure

Vivek T Kulkarni  1 , Nancy Kim  1 , Ying Dai  1 , Kumar Dharmarajan  1 , Kyan C Safavi  1 , Behnood Bikdeli  1 , Peter K Lindenauer  1 , Jeffrey Testani  1 , Daniel L Dries  1 , Harlan M Krumholz  2
Affiliations
Comparative Study

Hospital variation in noninvasive positive pressure ventilation for acute decompensated heart failure

Vivek T Kulkarni et al. Circ Heart Fail. 2014 May.

Abstract

Background: Although noninvasive positive pressure ventilation (NIPPV) for patients with acute decompensated heart failure was introduced almost 20 years ago, the variation in its use among hospitals remains unknown. We sought to define hospital practice patterns of NIPPV use for acute decompensated heart failure and their relationship with intubation and mortality.

Methods and results: We conducted a cross-sectional study using a database maintained by Premier, Inc., that includes a date-stamped log of all billed items for hospitalizations at >400 hospitals. We examined hospitalizations for acute decompensated heart failure in this database from 2005 to 2010 and included hospitals with annual average volume of >25 such hospitalizations. We identified 384 hospitals that encompassed 524 430 hospitalizations (median annual average volume: 206). We used hierarchical logistic regression models to calculate hospital-level outcomes: risk-standardized NIPPV rate, risk-standardized intubation rate, and in-hospital risk-standardized mortality rate. We grouped hospitals into quartiles by risk-standardized NIPPV rate and compared risk-standardized mortality rates and risk-standardized intubation rates across quartiles. Median risk-standardized NIPPV rate was 6.2% (interquartile range, 2.8%-9.3%; 5th percentile, 0.2%; 95th percentile, 14.8%). There was no clear pattern of risk-standardized mortality rates across quartiles. The bottom quartile of hospitals had higher risk-standardized intubation rate (11.4%) than each of the other quartiles (9.0%, 9.7%, and 9.1%; P<0.02 for all comparisons).

Conclusions: Substantial variation exists among hospitals in the use of NIPPV for acute decompensated heart failure without evidence for differences in mortality. There may be a threshold effect in relation to intubation rates, with the lowest users of NIPPV having higher intubation rates.

Keywords: heart failure; mortality; ventilation.

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Conflict of interest statement

Disclosures

The other authors report no conflicts.

Figures

Figure 1
Figure 1
Study Cohort
Figure 2
Figure 2
Distribution of Risk-Standardized Non-Invasive Positive Pressure Ventilation Rates among Hospitals
See this image and copyright information in PMC

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