Seoul National University College of Medicine, Seoul, Korea.
Division of Cardiology, Department of Internal Medicine, Daejeon Eulji University Hospital, Daejeon, Korea.
Korean J Intern Med. 2024 Nov;39(6):945-956. doi: 10.3904/kjim.2024.088. Epub 2024 Oct 24.
BACKGROUND/AIMS: Despite the proven benefit of the guideline-directed medical therapy (GDMT), it remains underutilized in patients hospitalized with acute heart failure (HF). We aimed to evaluate the impact of the discharge checklist on GDMT installation and the prognosis of HF patients.
This study was a single-center, observational study that included all patients admitted for HF from March 2021 to February 2023. The data were retrieved from electronic medical records and discharge checklists. A comparison was conducted between the checklist group and the non-checklist group. The primary endpoint was a composite of all-cause mortality or readmission for HF within 6 months.
The checklist was completed for 537 patients (checklist group) and not for 187 patients (non-checklist group). The proportion of patients to whom two or more components of GDMT were prescribed was significantly higher in the checklist group than in the non-checklist group (59.6% vs 42.2%, p < 0.001). The checklist group exhibited a significantly lower primary outcome compared to the non-checklist group (27.4% vs. 36.4%, HR 0.73, 95% CI 0.55-0.98, p = 0.036). The effect of the checklist was more prominent in HF with reduced ejection fraction (HR 0.51, 95% CI 0.34-0.77, p = 0.001) than in HF with mildly-reduced and preserved ejection fraction (HR 0.91, 95% CI 0.58-1.42, p = 0.676) (p for interaction = 0.06).
The implementation of the discharge checklist was associated with an improvement in GDMT prescription and an improved prognosis in patients with HF with reduced ejection fraction.
背景/目的：尽管指南指导的药物治疗（GDMT）已被证实有益，但在急性心力衰竭（HF）住院患者中的应用仍不充分。我们旨在评估出院清单对 GDMT 安装和 HF 患者预后的影响。
这是一项单中心、观察性研究，纳入了 2021 年 3 月至 2023 年 2 月期间因 HF 住院的所有患者。数据从电子病历和出院清单中检索。比较了清单组和非清单组。主要终点是 6 个月内全因死亡率或 HF 再入院的复合终点。
537 名患者（清单组）完成了清单，187 名患者（非清单组）未完成。与非清单组相比，清单组接受 GDMT 两种或两种以上药物治疗的患者比例明显更高（59.6%比 42.2%，p<0.001）。与非清单组相比，清单组的主要结局明显更低（27.4%比 36.4%，HR 0.73，95%CI 0.55-0.98，p=0.036）。清单的效果在射血分数降低的心力衰竭（HF）中更为显著（HR 0.51，95%CI 0.34-0.77，p=0.001），而在射血分数轻度降低和保留的心力衰竭中不显著（HR 0.91，95%CI 0.58-1.42，p=0.676）（p 交互=0.06）。
实施出院清单与 HF 患者 GDMT 处方的改善和射血分数降低的 HF 患者预后的改善相关。
