Division of Cardiology, Garibaldi-Nesima Hospital, Catania, Italy.
Heart Care Foundation, ANMCO Research Center, Florence, Italy.
Eur J Heart Fail. 2022 Nov;24(11):2078-2089. doi: 10.1002/ejhf.2605. Epub 2022 Jul 21.
To assess adherence to guideline recommendations among a large network of Italian cardiology sites in the management of acute and chronic heart failure (HF) and to evaluate if an ad-hoc educational intervention can improve their performance on several pharmacological and non-pharmacological indicators.
BLITZ-HF was a cross-sectional study based on a web-based recording system with pop-up reminders on guideline recommendations used during two 3-month enrolment periods carried out 3 months apart (Phase 1 and 3), interspersed by face-to-face macro-regional benchmark analyses and educational meetings (Phase 2). Overall, 7218 patients with acute and chronic HF were enrolled at 106 cardiology sites. During the enrolment phases, 3920 and 3298 patients were included, respectively, 84% with chronic HF and 16% with acute HF in Phase 1, and 74% with chronic HF and 26% with acute HF in Phase 3. At baseline, adherence to guideline recommendations was already overall high for most indicators. Among acute HF patients, an improvement was obtained in three out of eight indicators, with a significant rise in echocardiographic evaluation. Among chronic HF patients with HF and preserved or mid-range ejection fraction, performance increased in two out of three indicators: creatinine and echocardiographic evaluations. An overall performance improvement was observed in six out of nine indicators in ambulatory HF with reduced ejection fraction patients with a significant increase in angiotensin receptor-neprilysin inhibitor prescription rates.
Within a context of an already elevated level of adherence to HF guideline recommendations, a structured multifaceted educational intervention could be useful to improve performance on specific indicators. Extending this approach to other non-cardiology healthcare professionals, who usually manage patients with HF, should be considered.
评估意大利心脏病学网络中大量站点在急性和慢性心力衰竭（HF）管理中对指南建议的遵循情况，并评估专门的教育干预是否可以改善他们在几个药理学和非药理学指标上的表现。
BLITZ-HF 是一项基于网络的记录系统的横断面研究，该系统在两次 3 个月的登记期（第 1 期和第 3 期）中使用弹出式提醒，提示指南建议，两次登记期相隔 3 个月，期间穿插面对面的大区基准分析和教育会议（第 2 期）。共有 106 个心脏病学站点的 7218 名急性和慢性 HF 患者入组。在登记期内，分别纳入了 3920 名和 3298 名患者，第 1 期 84%为慢性 HF 患者，16%为急性 HF 患者，第 3 期 74%为慢性 HF 患者，26%为急性 HF 患者。基线时，大多数指标对指南建议的遵循已经很高。在急性 HF 患者中，八项指标中有三项得到了改善，超声心动图评估有显著提高。射血分数保留或中间范围的慢性 HF 患者中，有两项指标的表现得到了改善：肌酐和超声心动图评估。射血分数降低的慢性 HF 患者在九个指标中的六个指标中观察到总体表现改善，血管紧张素受体-脑啡肽酶抑制剂处方率显著增加。
在已经遵循 HF 指南建议的水平较高的情况下，结构化的多方面教育干预可能有助于改善特定指标的表现。应该考虑将这种方法扩展到其他通常管理 HF 患者的非心脏病学医疗保健专业人员。
