De Gennaro Luisa, Iacoviello Massimo, Donadeo Vittorio, Ruggiero Massimo, Brunetti Natale Daniele, Caldarola Pasquale
San Paolo Hospital Bari, Bari, Italy.
Department of Medical & Surgical Sciences, University of Foggia, Foggia, Italy.
Eur Heart J Suppl. 2022 May 18;24(Suppl C):C221-C224. doi: 10.1093/eurheartj/suac019. eCollection 2022 May.
The aim of this study was to evaluate the effects on the adherence of drug prescription to the guideline recommendations of a chronic care model based on the close interaction between hospital and local healthcare district cardiologists through a shared web-based database. From 2018 to 2021, patients hospitalized for an episode of acute decompensated heart failure (HF) ( or worsening) in cardiology wards from the healthcare district of Bari, Italy, were enrolled. The follow-up programme was based on a first visit after discharge within 1 month; patients were therefore addressed to the local health district cardiologist outpatient clinics when not requiring further invasive investigations and haemodynamically stable and followed-up with at least one visit every 6 months. In order to share in-hospital patients' data with outpatient clinics, at discharge, they were entered in a web-based database accessible for all cardiologists and centres participating in the Ponte Project. The group of patients affected by HF with reduced ejection fraction (HFrEF) were considered for the analyses. Drug prescription rates at 1-year follow-up were analysed as endpoint, as well as the re-admission for HF worsening. Out of 1200 HF patients enrolled in the project until December 2021, 56% were affected by HFrEF. At 1-year follow-up, 91% of patients were assuming beta-blockers, 86% mineralocorticoid receptor antagonists, 98% angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists/neprilysin angiotensin receptor antagonists, and 13% ARNI. Compared to patients enrolled before 2020, ARNI prescription increased in 2021 (60% vs. 13%, respectively, < 0.001). In 30% of patients, ARNI were prescribed before hospital discharge. Furthermore, in 10% of the population (most diabetics), sodium-glucose cotransporter 2 inhibitors were also prescribed. The implementation of the PONTE project was associated with an improved adherence to guidelines recommendations.
本研究的目的是通过一个基于网络的共享数据库，评估医院与当地医疗区心脏病专家密切互动的慢性护理模式对药物处方遵循指南建议情况的影响。2018年至2021年，招募了意大利巴里医疗区心脏病病房因急性失代偿性心力衰竭（HF）发作（或病情恶化）而住院的患者。随访计划基于出院后1个月内的首次就诊；因此，当患者不需要进一步的侵入性检查且血流动力学稳定时，会被转至当地医疗区心脏病专家门诊，并每6个月至少随访一次。为了与门诊共享住院患者的数据，出院时将他们录入一个所有参与Ponte项目的心脏病专家和中心都可访问的基于网络的数据库。分析纳入射血分数降低的心力衰竭（HFrEF）患者组。将1年随访时的药物处方率作为终点进行分析，以及HF病情恶化的再次入院情况。截至2021年12月，在该项目登记的1200例HF患者中，56%为HFrEF患者。在1年随访时，91%的患者正在服用β受体阻滞剂，86%服用盐皮质激素受体拮抗剂，98%服用血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂/中性肽链内切酶血管紧张素受体拮抗剂，13%服用ARNI。与2020年前登记的患者相比，2021年ARNI的处方量有所增加（分别为60%和13%，P＜0.001）。30%的患者在出院前就开具了ARNI。此外，10%的人群（大多数为糖尿病患者）还开具了钠-葡萄糖协同转运蛋白2抑制剂。Ponte项目的实施与对指南建议的依从性提高相关。
