Wang Pei-Yi, Lin Wen-Chih, Hsieh Pei-Chun, Lin Sheng-Hsiang, Liu Ping-Yen, Chao Ting-Hsing, Hsu Chih-Hsin
Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan.
Department of Nursing, National Taiwan University Hospital, Taipei.
Acta Cardiol Sin. 2023 Mar;39(2):287-296. doi: 10.6515/ACS.202303_39(2).20220923B.
The National Health Insurance Administration in Taiwan has promoted the heart failure post-acute care (HF-PAC) program as a means to provide proactive integrated care within the optimal treatment timeframe to enhance functional recovery after acute decompensated heart failure (HF).
The aim of this program was to reduce HF readmission rates, improved medication prescription rates, and improve the quality of life in HF patients.
Patients who had a reduced left ventricular ejection fraction (LVEF) of ≤ 40% were included and followed up for 6 months after discharge. They underwent cardiac rehabilitation and physiological, and nutritional status evaluations. The main clinical outcomes of the HF-PAC program were guideline-directed medical therapy prescription rate and 6-month readmission rate.
A total of 122 patients were recruited from June 2018 to December 2020 at a medical center in southern Taiwan. The patients' activities of daily living, nutritional status, quality of life and LVEF were significantly improved during the HF-PAC program. More than 95% of the patients received guideline-directed medical prescriptions at the end of the HF-PAC program. The cardiovascular-related 6-month re-admission rate after the HF-PAC program ended was 27.7%, and it could be predicted by the New York Health Association functional class [hazard ratio (HR) 95% confidence interval (95% CI) = 4.12 (1.36-12.46)], value of the Mini Nutritional Assessment - Short Form [HR (95% CI) = 0.46 (0.31-0.68)] and LVEF [HR (95% CI) = 0.95 (0.91-0.99)].
By incorporating multidisciplinary healthcare teams, the HF-PAC program improves the guideline- directed medical therapy prescription rate, thus improving patients' cardiac function, physical activity recovery, the quality of life, and also reduces their readmission rate.
台湾地区的国民健康保险署推行了心力衰竭急性后期照护（HF-PAC）计划，旨在最佳治疗时间范围内提供积极的综合照护，以促进急性失代偿性心力衰竭（HF）后的功能恢复。
该计划的目的是降低心力衰竭再入院率、提高药物处方率并改善心力衰竭患者的生活质量。
纳入左心室射血分数（LVEF）降低至≤40%的患者，并在出院后随访6个月。他们接受了心脏康复以及生理和营养状况评估。HF-PAC计划的主要临床结局为指南指导的药物治疗处方率和6个月再入院率。
2018年6月至2020年12月期间，台湾南部一家医疗中心共招募了122例患者。在HF-PAC计划期间，患者的日常生活活动能力、营养状况、生活质量和LVEF均有显著改善。超过95%的患者在HF-PAC计划结束时接受了指南指导的药物处方。HF-PAC计划结束后的心血管相关6个月再入院率为27.7%，可通过纽约心脏协会心功能分级[风险比（HR）95%置信区间（95%CI）=4.12（1.36-12.46）]、微型营养评定简表评分[HR（95%CI）=0.46（0.31-0.68）]和LVEF[HR（95%CI）=0.95（0.91-0.99）]进行预测。
通过整合多学科医疗团队，HF-PAC计划提高了指南指导的药物治疗处方率，从而改善了患者的心功能、身体活动恢复情况和生活质量，同时降低了再入院率。
