Preventative Cardiology, Baker Heart Research Institute, 75 Commercial Road, Melbourne, Victoria, 3004, Australia.
BMJ Qual Saf. 2011 Jan;20(1):31-7. doi: 10.1136/bmjqs.2008.028035.
Chronic heart-failure management programmes (CHF-MPs) have become part of standard care for patients with chronic heart failure (CHF).
To investigate whether programmes had applied evidence-based expert clinical guidelines to optimise patient outcomes.
A prospective cross-sectional survey was used to conduct a national audit.
Community setting of CHF-MPs for patients postdischarge.
All CHF-MPs operating during 2005-2006 (n=55). Also 10-50 consecutive patients from 48 programmes were recruited (n=1157).
(1) Characteristics and interventions used within each CHF-MP; and (2) characteristics of patients enrolled into these programmes.
Overall, there was a disproportionate distribution of CHF-MPs across Australia. Only 6.3% of hospitals nationally provided a CHF-MP. A total of 8000 postdischarge CHF patients (median: 126; IQR: 26-260) were managed via CHF-MPs, representing only 20% of the potential national case load. Significantly, 16% of the caseload comprised patients in functional New York Heart Association Class I with no evidence of these patients having had previous echocardiography to confirm a diagnosis of CHF. Heterogeneity of CHF-MPs in applied models of care was evident, with 70% of CHF-MPs offering a hybrid model (a combination of heart-failure outpatient clinics and home visits), 20% conducting home visits and 16% conducting an extended rehabilitation model of care. Less than half (44%) allowed heart-failure nurses to titrate medications. The main medications that were titrated in these programmes were diuretics (n=23, 96%), β-blockers (n=17, 71%), ACE inhibitors (ACEIs) (n=14, 58%) and spironolactone (n=9, 38%).
CHF-MPs are being implemented rapidly throughout Australia. However, many of these programmes do not adhere to expert clinical guidelines for the management of patients with CHF. This poor translation of evidence into practice highlights the inconsistency and questions the quality of health-related outcomes for these patients.
慢性心力衰竭管理计划（CHF-MP）已成为慢性心力衰竭（CHF）患者标准治疗的一部分。
研究这些计划是否应用了基于证据的专家临床指南来优化患者的治疗效果。
前瞻性横断面调查用于进行全国性审计。
CHF-MP 为出院后的 CHF 患者提供社区服务。
2005-2006 年期间运营的所有 CHF-MP（n=55）。还从 48 个项目中招募了 10-50 名连续患者（n=1157）。
（1）每个 CHF-MP 中使用的特征和干预措施；（2）参与这些计划的患者的特征。
总体而言，CHF-MP 在澳大利亚的分布不均衡。全国只有 6.3%的医院提供 CHF-MP。通过 CHF-MP 管理了总共 8000 名出院后 CHF 患者（中位数：126；IQR：26-260），仅占全国潜在病例数的 20%。值得注意的是，16%的病例数包括纽约心功能协会（NYHA）I 级功能的患者，没有证据表明这些患者之前进行过超声心动图检查以确认 CHF 的诊断。CHF-MP 在应用护理模式方面存在明显的异质性，70%的 CHF-MP 提供混合模式（心力衰竭门诊和家访的结合），20%进行家访，16%提供扩展康复护理模式。只有不到一半（44%）允许心力衰竭护士调整药物剂量。这些计划中调整的主要药物是利尿剂（n=23，96%）、β-受体阻滞剂（n=17，71%）、血管紧张素转换酶抑制剂（ACEI）（n=14，58%）和螺内酯（n=9，38%）。
CHF-MP 在澳大利亚迅速实施。然而，许多这样的计划并没有遵守 CHF 患者管理的专家临床指南。证据转化为实践的效果不佳突出了一致性问题，并对这些患者的健康相关结果的质量提出了质疑。
