exploration of the determinants of mortality among hospitalized heart failure patients in Ontario, Canada.
Published: 2004
Language: eng
Number of pages: 225
Description: In this thesis, we performed studies that serve as a foundation for research in heart failure mortality outcome assessment. Validation studies of the coding of heart failure in the Canadian Institute for Health Information discharge abstract database were performed. Comparison with clinical data sources confirmed the high predictive value of coding of heart failure in the administrative dataset, but undercoding of comorbidities. Using administrative datasets, trends in heart failure outcomes and the association with drug therapies were examined. Although significant changes in drug therapy were observed over time, crude mortality rates after index heart failure admission continued to be high, decreasing by 1.3% from 1992/93 to 1999/00. There was no decrease in 30-day mortality rates during this time. Since mortality remains high, a prognostic model for mortality prediction was developed and validated using clinical databases. Features predictive of mortality included age, presentation vital signs, routine laboratory tests, and comorbid conditions.Heart failure is associated with high rates of mortality and re-hospitalization. Variations in cardiovascular disease outcomes have been demonstrated to occur, and may reflect the quality of care provided. Mortality is fundamental in quality of care assessment because of the importance of process-outcome links and its role as an outcome indicator of quality care.Validation of administrative datasets allow for future studies of heart failure outcomes using clinical data sources. Predictive models for heart failure mortality can be used to adjust for patient risk when evaluating variations in heart failure outcomes, and may be useful for stratification of mortality risk.
Notes: Adviser: Jack V. Tu.

Thesis (Ph.D.)--University of Toronto, 2004.

Electronic version licensed for access by U. of T. users.

Source: Dissertation Abstracts International, Volume: 65-10, Section: B, page: 5065.