Department of Research & Evaluation News

A Kaiser Permanente Southern California research study found lower rates of heart failure mortality within the integrated health care system compared to the country as a whole.

“In our study, we analyzed the overall rates of death attributable to heart failure throughout the state of California and United States, and then compared that to what we are seeing here within Kaiser Permanente Southern California,” said lead author, Matthew T. Mefford, PhD, of the Kaiser Permanente Southern California Department of Research & Evaluation. “Given the aging of the U.S. population and increasing prevalence of heart failure, it’s important to understand what is driving the likelihood of death with heart failure.”

The study was published this month in BMC Cardiovascular Disorders.

Investigators began study after seeing intriguing trends

The study authors took on the research after noting that decreases in mortality rates due to cardiovascular diseases overall have slowed in recent years, but deaths due to heart failure have increased. Heart failure is a chronic, progressive form of heart disease in which the heart muscle does not pump blood as efficiently as it should. It is a debilitating condition that can result in a long period of declining quality of life.

Since cardiovascular disease, a disease of the blood vessels, is often a cause of heart failure, it was important for researchers to see what the trends were in Southern California. The increase in heart failure deaths is cause for concern because the number of adults over 65, who are at highest risk of heart disease, is projected to increase 44% in the United States from 2017 to 2030.

Research done with interventions in mind

The investigators examined the trends to help suggest potential interventions but did not examine the reasons why cardiovascular disease deaths decreased while heart failure deaths increased.

“We were interested in how this trend was playing out in an integrated health care system where there is better care, connected care, better adherence to care guidelines, and reduced disparities,” Dr. Mefford said. “We also wanted to see how our region was faring.”

Study looked at death trends at health system, state, and nation

The study examined trends in deaths that had heart failure as an underlying cause between 2001 and 2017. They then compared these trends to the state and nation.

Lower rates of heart failure deaths were observed within Kaiser Permanente Southern California compared to the United States and the rates were comparable to California.

• At Kaiser Permanente, rates of heart failure mortality increased by an average annual percent change of 1.3%.
• In California, rates of heart failure mortality also increased by an average annual percent change of 1.5%.
• The rate of heart failure mortality within the United States fluctuated but remained higher than KPSC and the state of California.
• Trends of heart failure mortality among Kaiser Permanente Southern California members ages 65 and older had slight steady increases between 2001 and 2017, consistent with the overall trend, while rates among members ages 45 to 64 years were lower.

The focus on combatting cardiovascular disease

“It’s not surprising that we have lower rates of heart failure mortality, given all the efforts we’ve had around blood pressure control, our Complete Care program, and our heart failure readmission program,” said the paper’s senior author, Kristi Reynolds, PhD, MPH. “Within Kaiser Permanente Southern California, we’ve really focused on trying to combat cardiovascular disease.”

Co-authors on the study in addition to Dr. Mefford and Dr. Reynolds were Zimin Zhuang, MS, Zhi Liang, PhD, Wansu Chen, PhD, of the Department of Research & Evaluation in Pasadena, Calif.; Sandra Y. Koyama, MD, of Kaiser Permanente Baldwin Park Medical Center in Baldwin Park, Calif.; Maria T. Taitano, MD, of Kaiser Permanente South Bay Medical Center in Harbor City, Calif.; Heather L. Watson, MBA/HCM, of the Kaiser Permanente Southern California Complete Care Support Programs in Pasadena, Calif.; Ming Sum Lee, MD, PhD, of the Kaiser Permanente Los Angeles Medical Center in Los Angeles, Calif.; and Stephen Sidney, MD, MPH, of the Division of Research, Kaiser Permanente Northern California in Oakland, Calif.

The study was funded by the Department of Research & Evaluation.