Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.
Heart. 2019 Mar;105(6):431-438. doi: 10.1136/heartjnl-2018-314129. Epub 2019 Jan 30.
To estimate the direction and magnitude of effect and quality of evidence for hospital-based heart failure (HF) quality improvement interventions on process of care measures and clinical outcomes among patients with acute HF.
We performed a structured search to identify relevant randomised trials evaluating the effect of in-hospital quality improvement interventions for patients hospitalised with HF through February 2017. Studies were independently reviewed in duplicate for key characteristics, outcomes were summarised and a qualitative synthesis was performed due to substantial heterogeneity.
From 3615 records, 14 randomised controlled trials were identified for inclusion with multifaceted interventions. There was a trend towards higher in-hospital use of ACE inhibitors (ACE-I; 57.9%vs40.0%) and beta-blockers (BBs; 46.7%vs10.2%) in the intervention than the comparator in one trial (n=429 participants). Five trials (n=78 727 participants) demonstrated no effect of the intervention on use of ACE-I or angiotensin receptor blocker at discharge. Three trials (n=89 660 participants) reported no effect on use of BB at discharge. Two trials (n=419 participants) demonstrated a trend towards lower hospital readmission up to 90 days after discharge. There was no consistent effect of the quality improvement intervention on 30-day all-cause mortality, hospital length of stay and patient-level health-related quality of life.
Randomised trials of hospital-based HF quality improvement interventions do not show a consistent effect on most process of care measures and clinical outcomes. The overall quality of evidence for the prespecified primary and key secondary outcomes was very low to moderate, suggesting that future research will likely influence these estimates.
CRD42016049545.
评估基于医院的心力衰竭（HF）质量改进干预对急性 HF 患者的护理措施和临床结局的方向和程度及证据质量。
我们进行了一项系统搜索，以确定截至 2017 年 2 月评估住院 HF 患者的院内质量改进干预效果的相关随机试验。研究结果由两名独立的研究人员进行了双重审查，总结了结果，并由于存在很大的异质性，因此进行了定性综合。
从 3615 条记录中，确定了 14 项纳入多方面干预措施的随机对照试验。一项试验（n=429 名参与者）显示，干预组比对照组更倾向于在住院期间更高地使用血管紧张素转换酶抑制剂（ACE-I；57.9%比 40.0%）和β受体阻滞剂（BB；46.7%比 10.2%）。五项试验（n=78727 名参与者）表明，干预对出院时 ACE-I 或血管紧张素受体阻滞剂的使用没有影响。三项试验（n=89660 名参与者）报告称，出院时 BB 的使用没有影响。两项试验（n=419 名参与者）表明，出院后 90 天内的住院再入院率呈下降趋势。质量改进干预对 30 天全因死亡率、住院时间和患者水平的健康相关生活质量没有一致的影响。
基于医院的 HF 质量改进干预的随机试验并未显示对大多数护理措施和临床结局的一致影响。针对预先指定的主要和关键次要结局的总体证据质量为低至中度，表明未来的研究可能会影响这些估计。
CRD42016049545。
