Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
BMC Health Serv Res. 2013 Oct 5;13:391. doi: 10.1186/1472-6963-13-391.
The treatment of heart failure (HF) is complex and the prognosis remains serious. A range of strategies is used across health care systems to improve the quality of care for HF patients. We present results from a nationwide multidisciplinary initiative to monitor and improve the quality of care and clinical outcome of HF patients using indicator monitoring combined with systematic auditing.
We conducted a nationwide, population-based prospective study using data from the Danish Heart Failure Registry. The registry systematically monitors and audits the use of guideline recommended processes of care at Danish hospital departments treating incident HF patients. We identified patients registered between 2003 and 2010 (n = 24,504) and examined changes in use of recommended processes of care and 1-year mortality.
The use of the majority of the recommended processes of care increased substantially from 2003 to 2010: echocardiography (from 62.7% to 90.5%; Relative Risk (RR) 1.45 (95% CI, 1.39-1.50)), New York Heart Association classification (from 29.4% to 85.5%; RR 2.91 (95% CI, 2.69-3.14)), betablockers (from 72.6% to 88.3%; RR 1.23 (95% CI, 1.15-1.29)), physical training (from 5.6% to 22.8%; RR 4.04 (95% CI, 2.96-4.52)), and patient education (from 49.3% to 81.4%; RR 1.65 (95% CI, 1.52-1.80)). Use of ACE/ATII inhibitors remained stable (from 92.0% to 93.2%; RR 1.01 (95% CI, 0.99-1.04)). During the same period, 1-year mortality dropped from 20.5% to 12.8% (adjusted Hazard Ratio 0.79 (95% CI, 0.65-0.96).
Use of guideline recommended processes of care has improved among patients with incident HF included in the Danish Heart Failure Registry between 2003 and 2010. During the same period, a decrease in mortality was observed.
心力衰竭（HF）的治疗较为复杂，预后仍然较为严重。各医疗体系采用了一系列策略来提高 HF 患者的护理质量。我们报告了一项全国性多学科倡议的结果，该倡议使用指标监测和系统审核来监测和改善 HF 患者的护理质量和临床结局。
我们进行了一项全国性、基于人群的前瞻性研究，使用丹麦心力衰竭登记处的数据。该登记处系统地监测和审核丹麦医院科室治疗新发 HF 患者时指南推荐的护理流程的使用情况。我们确定了 2003 年至 2010 年期间登记的患者（n=24504），并检查了推荐的护理流程使用情况和 1 年死亡率的变化。
从 2003 年到 2010 年，大多数推荐的护理流程的使用大幅增加：超声心动图（从 62.7%增加到 90.5%；相对风险（RR）1.45（95%可信区间，1.39-1.50）），纽约心脏协会分类（从 29.4%增加到 85.5%；RR 2.91（95%可信区间，2.69-3.14）），β受体阻滞剂（从 72.6%增加到 88.3%；RR 1.23（95%可信区间，1.15-1.29）），体力训练（从 5.6%增加到 22.8%；RR 4.04（95%可信区间，2.96-4.52））和患者教育（从 49.3%增加到 81.4%；RR 1.65（95%可信区间，1.52-1.80））。ACE/ATII 抑制剂的使用保持稳定（从 92.0%增加到 93.2%；RR 1.01（95%可信区间，0.99-1.04））。在此期间，1 年死亡率从 20.5%下降到 12.8%（调整后的风险比 0.79（95%可信区间，0.65-0.96））。
在 2003 年至 2010 年期间，丹麦心力衰竭登记处登记的新发 HF 患者中，指南推荐的护理流程的使用有所改善。在此期间，死亡率有所下降。
