Suchina Justas, Lüthi-Corridori Giorgia, Jaun Fabienne, Leuppi Jörg D, Boesing Maria
University Institute of Internal Medicine, Cantonal Hospital Baselland, CH-4410 Liestal, Switzerland.
Faculty of Medicine, University of Basel, CH-4056 Basel, Switzerland.
J Clin Med. 2024 Oct 7;13(19):5951. doi: 10.3390/jcm13195951.
: Acute Heart Failure (AHF) is a leading cause of hospitalizations and remains a significant socioeconomic burden. Despite advances in medical care, mortality and rehospitalization rates remain high. Previous AHF audits have revealed regional differences and a poor adherence to guidelines. This study aimed to assess guideline adherence in a public teaching hospital to identify areas for improvement. : This retrospective observational study examined clinical routine data of patients hospitalized for AHF at a Swiss public teaching hospital between 2018 and 2019. AHF management was evaluated against the relevant guidelines of the European Society of Cardiology. : The study included 760 AHF cases of 726 patients (median age 84 years, range 45-101, 50% female). NT-pro-BNP levels were measured in 92% of the cases. Electrocardiography was performed in 95% and chest X-rays in 90% of cases. Echocardiography was conducted in 54% of all cases and in 63% of newly diagnosed AHF cases. Intravenous furosemide was initiated in 76%. In the subgroup of cases with reduced ejection fraction (HFrEF), 86% were discharged with beta-blockers and 69% with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. Among cases with left ventricular ejection fraction ≤ 35%, mineralocorticoid receptor antagonists were prescribed in 55%. : We observed generally good adherence to guideline recommendations. However, several improvements are needed in initial assessment and documentation, diagnostic procedures such as echocardiography, discharge medication, and lifestyle recommendations. Compared to other studies, our diagnostic workup was more aligned with guidelines, the use of intravenous diuretics was similar, and the duration of hospital stay and mortality rates were comparable.
急性心力衰竭（AHF）是住院治疗的主要原因，并且仍然是一项重大的社会经济负担。尽管医疗护理有所进步，但死亡率和再住院率仍然很高。以往的AHF审计显示存在地区差异且对指南的遵循情况不佳。本研究旨在评估一家公立教学医院对指南的遵循情况，以确定需要改进的领域。：这项回顾性观察性研究检查了2018年至2019年期间在一家瑞士公立教学医院因AHF住院的患者的临床常规数据。根据欧洲心脏病学会的相关指南对AHF管理进行评估。：该研究纳入了726例患者的760例AHF病例（中位年龄84岁，范围45 - 101岁，50%为女性）。92%的病例测量了N末端B型利钠肽原（NT-pro-BNP）水平。95%的病例进行了心电图检查，90%的病例进行了胸部X光检查。所有病例中有54%进行了超声心动图检查，新诊断的AHF病例中有63%进行了超声心动图检查。76%的患者开始静脉注射呋塞米。在射血分数降低（HFrEF）的病例亚组中，86%的患者出院时使用β受体阻滞剂，69%的患者使用血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂。在左心室射血分数≤35%的病例中，55%的患者使用了盐皮质激素受体拮抗剂。：我们观察到对指南建议的总体遵循情况良好。然而，在初始评估和记录、超声心动图等诊断程序、出院用药以及生活方式建议方面仍需要一些改进。与其他研究相比，我们的诊断检查更符合指南，静脉利尿剂的使用情况相似，住院时间和死亡率也相当。
