Zafar Rizwan, Haris Muhammad, Assad Salman, Shabbir Muhammad Usman, Ghazanfar Haider, Malik Sarah A, Khalid Tehreem, Abbas Ali H, Saleem Asad A
Department of Cardiology, Shifa College of Medicine, Islamabad, Pakistan.
Department of Neurology & Neurosurgery, Shifa Tameer-e-Millat University, Islamabad, Pakistan.
Cureus. 2016 Aug 8;8(8):e728. doi: 10.7759/cureus.728.
Heart failure presents a huge burden for individual patients and the healthcare system as a whole. This study aims to assess the adherence to these core measures as identified by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)/ American Heart Association (AHA) by physicians of Pakistan.
We conducted a cross-sectional study in Shifa International Hospital, Islamabad, Pakistan from the period of April 2013 to April 2016. Patients with a primary diagnosis of heart failure were drawn from a coding section of hospital's record department. Data was evaluated to assess how strictly doctors were following core measures identified by JCAHO/AHA for the given diagnosis. Inclusion criteria for this study were patients ≥ 17 years of age and patients with a primary diagnosis of heart failure according to New York Heart Association (NYHA) classification. Patients with congenital anomalies and structural heart wall problems, like sarcoidosis, hemochromatosis, and amyloidosis, were excluded from the study.
Mean ejection fraction (EF) was found to be 27.23 ± 11.72 percent. Symptoms assessment of heart failure was done in 16/421 (3.8%) patients according to NYHA classification and in 405/421 (96.2%) patients according to outpatient-based heart failure assessment based on physician's experience other than NYHA classification. Left ventricle ejection fraction (LVEF) was assessed in 411/421 (97%) patients. Out of these, 336/411 (81.7%) patients had EF < 40%. Mean EF was found to be significantly higher in females as compared to males (p < 0.001). Three hundred and thirty-six out of 411 (81.7%) patients with EF < 40% needed angiotensin converting enzyme inhibitors (ACEi) and beta-blocker (BB) prescriptions. ACEi were prescribed only to 230/336 (68.7%) patients and 248/336 (73.8%) patients were given BB with documented contraindication to ACEi and BB in 7.36% and 17% patients, respectively. There was no significant association between gender and mean duration of hospitalization (p = 0.411). No significant association was found between EF ≤ 40% and mean duration of hospitalization (p = 0.426).
We found that symptom assessment of congestive heart failure (CHF) patients, according to NYHA guidelines, are strikingly low. Also, a significant percentage of patients who need ACEi and BB are not prescribed the required medications despite echocardiography showing low left ventricular function.
心力衰竭给个体患者及整个医疗保健系统带来了巨大负担。本研究旨在评估巴基斯坦医生对医疗机构评审联合委员会（JCAHO）/美国心脏协会（AHA）所确定的这些核心措施的依从性。
我们于2013年4月至2016年4月在巴基斯坦伊斯兰堡的希法国际医院进行了一项横断面研究。原发性心力衰竭患者从医院记录部门的编码科室选取。对数据进行评估，以评估医生对JCAHO/AHA针对给定诊断所确定的核心措施的遵循程度。本研究的纳入标准为年龄≥17岁且根据纽约心脏协会（NYHA）分类为原发性心力衰竭的患者。患有先天性异常和结构性心脏壁问题（如结节病、血色素沉着症和淀粉样变性）的患者被排除在研究之外。
平均射血分数（EF）为27.23±11.72%。根据NYHA分类，16/421（3.8%）的患者进行了心力衰竭症状评估，而根据基于医生经验而非NYHA分类的门诊心力衰竭评估，405/421（96.2%）的患者进行了评估。411/421（97%）的患者进行了左心室射血分数（LVEF）评估。其中，336/411（81.7%）的患者EF<40%。发现女性的平均EF显著高于男性（p<0.001）。411例EF<40%的患者中有336例（81.7%）需要血管紧张素转换酶抑制剂（ACEi）和β受体阻滞剂（BB）处方。ACEi仅开给230/336（68.7%）的患者，248/336（73.8%）的患者接受了BB治疗，分别有7.36%和17%的患者有ACEi和BB的记录在案的禁忌证。性别与平均住院时间之间无显著关联（p = 0.411）。EF≤40%与平均住院时间之间未发现显著关联（p = 0.426）。
我们发现，根据NYHA指南，充血性心力衰竭（CHF）患者的症状评估极低。此外，尽管超声心动图显示左心室功能低下，但很大一部分需要ACEi和BB的患者并未被开具所需药物。
