Linssen G C M, Veenis J F, Brunner-La Rocca H P, van Pol P E J, Engelen D J M, van Tooren R M, Koornstra-Wortel H J J, Hoes A W, Brugts J J
Department of Cardiology, Hospital Group Twente, Almelo and Hengelo, Almelo, The Netherlands.
Erasmus Medical Center, Department of Cardiology, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Neth Heart J. 2020 Jun;28(6):334-344. doi: 10.1007/s12471-020-01421-1.
Heart failure (HF) is associated with poor prognosis, high morbidity and mortality. The prognosis can be optimised by guideline adherence, which also can be used as a benchmark of quality of care. The purpose of this study was to evaluate differences in use of HF medication between Dutch HF clinics.
The current analysis was part of a cross-sectional registry of 10,910 chronic HF patients at 34 Dutch outpatient clinics in the period of 2013 until 2016 (CHECK-HF), and focused on the differences in prescription rates between the participating clinics in patients with heart failure with reduced ejection fraction (HFrEF).
A total of 8,360 HFrEF patients were included with a mean age of 72.3 ± 11.8 years (ranging between 69.1 ± 11.9 and 76.6 ± 10.0 between the clinics), 63.9% were men (ranging between 54.3 and 78.1%), 27.3% were in New York Heart Association (NYHA) class III/IV (ranging between 8.8 and 62.1%) and the average estimated glomerular filtration rate (eGFR) was 59.6 ± 24.6 ml/min (ranging between 45.7 ± 23.5 and 97.1 ± 16.5). The prescription rates ranged from 58.9-97.4% for beta blockers (p < 0.01), 61.9-97.1% for renin-angiotensin system (RAS) inhibitors (p < 0.01), 29.9-86.8% for mineralocorticoid receptor antagonists (MRAs) (p < 0.01), 0.0-31.3% for ivabradine (p < 0.01) and 64.9-100.0% for diuretics (p < 0.01). Also, the percentage of patients who received the target dose differed significantly, 5.9-29.1% for beta blockers (p < 0.01), 18.4-56.1% for RAS inhibitors (p < 0.01) and 13.2-60.6% for MRAs (p < 0.01).
The prescription rates and prescribed dosages of guideline-recommended medication differed significantly between HF outpatient clinics in the Netherlands, not fully explained by differences in patient profiles.
心力衰竭（HF）与不良预后、高发病率和死亡率相关。遵循指南可优化预后，其也可作为医疗质量的基准。本研究的目的是评估荷兰心力衰竭诊所之间心力衰竭药物使用的差异。
当前分析是2013年至2016年期间荷兰34家门诊诊所10910例慢性心力衰竭患者横断面登记研究（CHECK-HF）的一部分，重点关注射血分数降低的心力衰竭（HFrEF）患者中参与诊所之间的处方率差异。
共纳入8360例HFrEF患者，平均年龄72.3±11.8岁（各诊所之间范围为69.1±11.9至76.6±10.0岁），63.9%为男性（范围为54.3%至78.1%），27.3%为纽约心脏协会（NYHA）Ⅲ/Ⅳ级（范围为8.8%至62.1%），平均估计肾小球滤过率（eGFR）为59.6±24.6 ml/min（范围为45.7±23.5至97.1±16.5）。β受体阻滞剂的处方率为58.9 - 97.4%（p<0.01），肾素 - 血管紧张素系统（RAS）抑制剂为61.9 - 97.1%（p<0.01），盐皮质激素受体拮抗剂（MRAs）为29.9 - 86.8%（p<0.01），伊伐布雷定为0.0 - 31.3%（p<0.01），利尿剂为64.9 - 100.0%（p<0.01）。此外，接受目标剂量的患者百分比也有显著差异，β受体阻滞剂为5.9 - 29.1%（p<0.01），RAS抑制剂为18.4 - 56.1%（p<0.01），MRAs为13.2 - 60.6%（p<0.01）。
荷兰心力衰竭门诊诊所之间指南推荐药物的处方率和规定剂量存在显著差异，患者特征差异不能完全解释这些差异。
