Tan Sie Sie, Hisham Shairyzah Ahmad, Bin Abdul Malek Abdul Muizz, Lik Chua Ping, Lau Glendon Seng Kiong, Bin Abdul Ghapar Abdul Kahar
, BScPhm, RPh, MClinPharm, is a clinical pharmacist with Sultan Idris Shah Serdang Hospital, Selangor, Malaysia.
, PhD, MedSc, is with the Faculty of Pharmacy, University of Cyberjaya, Selangor, Malaysia.
Can J Hosp Pharm. 2024 Jan 10;77(1):e3364. doi: 10.4212/cjhp.3364. eCollection 2024.
Heart failure (HF) is associated with recurrent hospital admissions and high mortality. Guideline-directed medical therapy has been shown to improve prognosis for patients who have HF with reduced ejection fraction (HFrEF). Despite the proven benefits of guideline-directed medical therapy, its utilization is less than optimal among patients with HF in Malaysia.
To determine the impact of a multidisciplinary team HF (MDT-HF) clinic on the use of guideline-directed medical therapy and patients' clinical outcomes at 1 year.
This retrospective study was conducted in a single cardiac centre in Malaysia. Patients with HFrEF who were enrolled in the MDT-HF clinic between November 2017 and June 2020 were compared with a matched control group who received the standard of care. Data were retrieved from the hospital electronic system and were analyzed using statistical software.
A total of 54 patients were included in each group. Patients enrolled in the MDT-HF clinic had higher usage of renin-angiotensin system blockers (54 [100%] vs 47 [87%], p < 0.001) and higher attainment of the target dose for these agents (35 [65%] vs 5 [9%], p < 0.001). At 1 year, the mean left ventricular ejection fraction (LVEF) was significantly greater in the MDT-HF group (35.7% [standard deviation 12.3%] vs 26.2% [standard deviation 8.7%], p < 0.001), and care in the MDT-HF clinic was significantly associated with better functional class, with a lower proportion of patients categorized as having New York Heart Association class III HF at 1 year (1 [2%] vs 14 [26%], p = 0.001). Patients in the MDT-HF group also had a significantly lower rate of readmission for HF (4 [7%] vs 32 [59%], p < 0.001).
Patients who received care in the MDT-HF clinic had better use of guideline-directed medical therapy, greater improvement in LVEF, and a lower rate of readmission for HF at 1 year relative to patients who received the standard of care.
心力衰竭（HF）与反复住院和高死亡率相关。对于射血分数降低的心力衰竭（HFrEF）患者，指南指导的药物治疗已被证明可改善其预后。尽管指南指导的药物治疗已证实具有益处，但在马来西亚的HF患者中，其使用率仍未达到最佳水平。
确定多学科团队心力衰竭（MDT-HF）门诊对指南指导的药物治疗的使用情况以及患者1年临床结局的影响。
本回顾性研究在马来西亚的一个心脏中心进行。将2017年11月至2020年6月期间纳入MDT-HF门诊的HFrEF患者与接受标准治疗的匹配对照组进行比较。数据从医院电子系统中获取，并使用统计软件进行分析。
每组共纳入54例患者。纳入MDT-HF门诊的患者肾素-血管紧张素系统阻滞剂的使用率更高（54例[100%]对47例[87%]，p<0.001），且这些药物达到目标剂量的比例更高（35例[65%]对5例[9%]，p<0.001）。1年时，MDT-HF组的平均左心室射血分数（LVEF）显著更高（35.7%[标准差12.3%]对26.2%[标准差8.7%]，p<0.001），并且MDT-HF门诊的治疗与更好的功能分级显著相关，1年时被归类为纽约心脏协会III级HF的患者比例更低（1例[2%]对14例[26%]，p = 0.001）。MDT-HF组患者因HF再次入院的发生率也显著更低（4例[7%]对32例[59%]，p<0.001）。
与接受标准治疗的患者相比，在MDT-HF门诊接受治疗的患者对指南指导的药物治疗的使用情况更好，LVEF改善更大，且1年时因HF再次入院的发生率更低。
