Fedyk-Łukasik Małgorzata, Wizner Barbara, Opolski Grzegorz, Zdrojewski Tomasz, Czech Marcin, Dubiel Jacek S, Marchel Michał, Rywik Tomasz, Korewicki Jerzy, Grodzicki Tomasz
Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland, Poland.
Kardiol Pol. 2017;75(6):527-534. doi: 10.5603/KP.a2017.0040. Epub 2017 Mar 29.
Optimal management of heart failure (HF) patients is crucial to reduce both mortality and the number of hospital admissions, at the same time improving patients' quality of life.
The aim of the study was to assess the quality of care of hospitalised patients with HF in Poland in 2013 and compare it with the results of a similar survey performed in 2005.
The presented study was conducted from April to November 2013 in a sample of 260 hospital wards in Poland, recruited by stratified proportional sampling. Similarly to the first study edition in 2005, a trained nurse contacted physicians, who filled out the study questionnaires on the last five patients with HF, who had been discharged from an internal or cardiological ward. HF did not have to be a major cause of hospital admission.
The mean age of the 1300 hospitalised patients was 72.1 years, an increase of 2.3 years since the 2005 survey. The proportion of patients classified as New York Heart Association IV decreased from 28.5% in 2005 to 22.1% in 2013. In comparison with 2005, more patients had concomitant disorders such as hypertension (79.5% vs. 71.0%), diabetes (46.2% vs. 33.2%), and chronic renal failure (33.4% vs. 19.4%). Access to echocardiography has improved in recent years: it was available for 98.9% of the surveyed hospital wards (93% in 2005) and it was performed during the hospitalisation in 60.2% of the patients (58.8% in 2005). In 2013 N-terminal pro-B-type natriuretic peptide was accessible for 80.8% of hospital wards (12.8% in 2005) and the test was performed in 31.3% of the hospitalised patients (3.3% in 2005). Angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blockers (ARB) were administered in 68.9% of HF discharged patients, beta-blockers in 84.8%, mineralocorticoid receptor antagonist (MRA) in 57.9%, diuretics in 85.9%, and digoxin in 23%. The respective numbers in 2005 were 85.9%, 76.0%, 65.4%, 88.9%, and 38.4%. The decrease in prescription of ACEI or ARB resulted from lesser usage of these drugs in internal medicine wards (from 84.3% in 2005 to 55.6% in 2013).
In comparison to the analogous project run in 2005, an improvement in some areas of HF treatment was observed in Polish hospitals, such as accessibility to echocardiography and natriuretic peptide measurement as well as beta-blocker and MRA use. At the same time, a meaningful decrease in ACEIs or ARBs usage in internal wards was observed, which might be the result of the ageing of the HF population and an increased number of comorbidities.
心力衰竭（HF）患者的最佳管理对于降低死亡率和减少住院次数至关重要，同时还能提高患者的生活质量。
本研究旨在评估2013年波兰住院HF患者的护理质量，并将其与2005年进行的类似调查结果进行比较。
本研究于2013年4月至11月在波兰的260个医院病房样本中进行，采用分层比例抽样法招募。与2005年的首次研究版本类似，一名经过培训的护士联系医生，医生填写关于最后五名从内科或心内科病房出院的HF患者的研究问卷。HF不一定是住院的主要原因。
1300名住院患者的平均年龄为72.1岁，自2005年调查以来增加了2.3岁。被归类为纽约心脏协会IV级的患者比例从2005年的28.5%降至2013年的22.1%。与2005年相比，更多患者患有合并症，如高血压（79.5%对71.0%）、糖尿病（46.2%对33.2%）和慢性肾衰竭（33.4%对19.4%）。近年来超声心动图的可及性有所改善：98.9%的被调查医院病房可以进行（2005年为93%），60.2%的患者在住院期间进行了该项检查（2005年为58.8%）。2013年，80.8%的医院病房可以检测N末端B型利钠肽前体（2005年为12.8%），31.3%的住院患者进行了该项检测（2005年为3.3%）。68.9%的HF出院患者使用了血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB），84.8%使用了β受体阻滞剂，57.9%使用了盐皮质激素受体拮抗剂（MRA），85.9%使用了利尿剂，23%使用了地高辛。2005年的相应数字分别为85.9%、76.0%、65.4%、88.9%和38.4%。ACEI或ARB处方的减少是由于内科病房对这些药物的使用减少（从2005年的84.3%降至2013年的55.6%）。
与2005年开展的类似项目相比，波兰医院在HF治疗的某些方面有所改善，如超声心动图和利钠肽测量的可及性以及β受体阻滞剂和MRA的使用。同时，观察到内科病房中ACEI或ARB的使用显著减少，这可能是HF患者老龄化和合并症数量增加的结果。
