Didomenico Robert J, Perez Alexandra, Schumann Heather M, Fontana Dee R, Kondos George T, Schumock Glen T
Department of Pharmacy Practice and Affiliate Faculty, Center for Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, Chicago, IL 60612, USA.
Ann Pharmacother. 2008 Mar;42(3):327-33. doi: 10.1345/aph.1K496. Epub 2008 Feb 26.
No data exist that demonstrate the impact of comprehensive acute decompensated heart failure (ADHF) treatment guidelines on clinical and economic outcomes in hospitalized patients with this condition.
To compare clinical and economic outcomes before and after implementation of treatment guidelines for ADHF.
A single-center, retrospective, chart review study was conducted in a university hospital. ADHF treatment guidelines were developed and implemented on January 1, 2004. Patients hospitalized for ADHF between January 2003 and November 2004 were identified using the Acute Decompensated Heart Failure Registry. Study periods were 12 months prior to and the 11 months following guideline implementation.
This cohort was comprised of 683 ADHF hospitalizations (357 preguideline, 326 postguideline); several patients were admitted more than once. There was a trend toward increased use of intravenous vasoactive drugs (VADs) following guideline implementation (19.9% vs 24.2%; p = 0.05). The duration of intravenous VAD use decreased by more than 40% following guideline implementation, but this was not statistically significant after risk adjustment (p = 0.22). The need for intensive care unit monitoring decreased from 45.1% before guideline implementation to 25.3% following guideline implementation (p < 0.02) in patients treated with intravenous VADs. The need for mechanical ventilation was reduced by nearly 80% (p = 0.04) following guideline implementation. Significantly more patients of the postguideline cohort were prescribed beta-blockers at discharge (54.9% vs 75.2%; p = 0.0001). Costs were not significantly different between the groups.
Implementation of ADHF treatment guidelines was associated with reduced need for mechanical ventilation, improved utilization of beta-blockers at discharge, and trends toward increased use of intravenous VADs, while not significantly changing total costs. More rigorous studies need to be conducted to estimate the true effect of treatment guidelines on ADHF care and outcomes.
尚无数据表明综合性急性失代偿性心力衰竭（ADHF）治疗指南对患有该疾病的住院患者的临床及经济结局产生的影响。
比较ADHF治疗指南实施前后的临床及经济结局。
在一家大学医院开展了一项单中心、回顾性图表审查研究。ADHF治疗指南于2004年1月1日制定并实施。使用急性失代偿性心力衰竭登记册确定2003年1月至2004年11月期间因ADHF住院的患者。研究期为指南实施前12个月及实施后11个月。
该队列包括683例ADHF住院病例（指南实施前357例，指南实施后326例）；部分患者多次入院。指南实施后静脉血管活性药物（VADs）的使用有增加趋势（19.9%对24.2%；p = 0.05）。指南实施后静脉使用VADs的持续时间减少了40%以上，但风险调整后这一差异无统计学意义（p = 0.22）。接受静脉VADs治疗的患者中，重症监护病房监测需求从指南实施前的45.1%降至实施后的25.3%（p < 0.02）。指南实施后机械通气需求减少了近80%（p = 0.04）。指南实施后队列中出院时开具β受体阻滞剂的患者显著增多（54.9%对75.2%；p = 0.0001）。两组间成本无显著差异。
ADHF治疗指南的实施与机械通气需求减少、出院时β受体阻滞剂使用情况改善以及静脉VADs使用增加趋势相关，同时未显著改变总成本。需要开展更严格的研究以评估治疗指南对ADHF治疗及结局的真实影响。
