Nohria A, Chen Y T, Morton D J, Walsh R, Vlasses P H, Krumholz H M
Section of Cardiovascular Medicine, Department of Medicine, Yale-New Haven Hospital Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT 06520-8025, USA.
Am Heart J. 1999 Jun;137(6):1028-34. doi: 10.1016/s0002-8703(99)70358-3.
The purpose of this study was to determine the standard of care provided by academic medical centers for the management of congestive heart failure (CHF).
The standard of care was estimated by assessing adherence to the treatment guidelines published by the US Agency for Health Care Policy and Research among 522 patients hospitalized at 7 university hospitals with a diagnosis of CHF. Data were abstracted by retrospective chart review. Of the 522 patients analyzed, 435 (83%) had a left ventricular ejection fraction (LVEF) measured or documented. Among these patients, 192 were considered "ideal" candidates for angiotensin-converting enzyme (ACE) inhibitor therapy (ie, with systolic dysfunction [LVEF <40%] and no contraindications to ACE inhibitors). In this cohort of "ideal" candidates, 138 (72%) were receiving ACE inhibitors at hospital discharge, including 60 (44%) who were prescribed doses recommended in large clinical trials. Compliance with patient education guidelines was assessed in all 487 patients who were alive at the time of discharge. Of these patients, 365 (75%) received dietary counseling, 404 (83%) were educated about exercise, 54 (11%) were instructed to follow daily weights, and 468 (96%) were counseled regarding medication compliance. Among the 87 smokers who were alive at time of discharge, 8 (9%) had documented advice to quit smoking.
This study indicates that academic medical centers performed fairly well on the assessment of LVEF, the prescription of ACE inhibitors at discharge, and on education regarding diet, exercise, and compliance with medications. However, the results suggest opportunities for improvement in ACE inhibitor dosing and patient education regarding the importance of monitoring daily weights and smoking cessation.
本研究的目的是确定学术医疗中心对充血性心力衰竭（CHF）管理所提供的护理标准。
通过评估7家大学医院收治的522例诊断为CHF的患者对美国医疗保健政策与研究机构发布的治疗指南的遵循情况，来估计护理标准。数据通过回顾性病历审查提取。在分析的522例患者中，435例（83%）测量或记录了左心室射血分数（LVEF）。在这些患者中，192例被认为是血管紧张素转换酶（ACE）抑制剂治疗的“理想”候选者（即收缩功能障碍[LVEF<40%]且无ACE抑制剂禁忌证）。在这组“理想”候选者中，138例（72%）出院时接受了ACE抑制剂治疗，其中60例（44%）接受了大型临床试验推荐的剂量。对出院时存活的所有487例患者的患者教育指南遵循情况进行了评估。在这些患者中，365例（75%）接受了饮食咨询，404例（83%）接受了运动教育，54例（11%）被指导记录每日体重，468例（96%）接受了药物依从性咨询。在出院时存活的87例吸烟者中，8例（9%）有戒烟的书面建议。
本研究表明，学术医疗中心在LVEF评估、出院时ACE抑制剂的处方以及饮食、运动和药物依从性教育方面表现相当不错。然而，结果表明在ACE抑制剂剂量调整以及关于监测每日体重和戒烟重要性的患者教育方面仍有改进空间。
