Li Zhenlong, Wang Yuxia, Hu Dan, Huang Jianming, Zhang Yi
Department of Emergency, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi, China.
Huangshi Emergency Center, Huangshi, China.
Cardiovasc Diagn Ther. 2025 Feb 28;15(1):128-136. doi: 10.21037/cdt-24-437. Epub 2025 Feb 21.
Heart failure (HF) is the end stage of various heart disease. An increasing number of HF centers have emerged in China, which aimed to facilitate standardized, multidisciplinary, and scientific management for HF patients. The study aimed to observe whether the establishment of HF center has positive effect on standardized management and prognosis of HF patients.
A before and after study was performed by randomly collecting a total of 300 cases of medical records and follow-up data in the HF database of our hospital (Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University). Referring to the certification date (December 2020) of our center, 150 cases were selected into the center group (January 2021-December 2022, after certification) and 150 cases in the control group (January 2019-December 2020, before certification). Statistical comparison between two groups was performed, which focused on indicators of standardized management [proportion of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and echocardiography performed in the diagnosis of HF, application ratio of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB)/angiotensin receptor neprilysin inhibitor (ARNI), β-blockers in heart failure with reduced ejection fraction (HFrEF) patients, 1 week, 1 month, 3 months and 1 year follow-up rate] and clinical prognosis indicators (NT-proBNP level, 6-minute walking distance test, heart function grading, shorter average duration in hospital) at discharge, review of relevant indicators after 1 year, readmission rate and incidence of main adverse cardiovascular and cerebrovascular events (MACCEs) in 1 year.
Compared to the control group, the proportion of patients using NT-proBNP (94.7% 87.3%, P=0.03), echocardiography (88.7% 78.7%, P=0.02), the ratio of patients using ACEI/ARB/ARNI (87.0% 72.2%, P=0.03) and β-blocker (82.7% 66.7%, P=0.03) before discharge, and the follow-up rate of each period after discharge (1 week, 90.7% 80.0%, P=0.01; 1 month, 84.7% 72.0%, P=0.01; 3 months, 76.7% 64.0%, P=0.02; 1 year, 88.0% 79.3%, P=0.04) was higher in the center group. Treated with standardized management, patients in the center group had a lower NT-proBNP level (1,760±934 2,279±1,085 pg/mL, P<0.001), a further 6-minute walking test distance (364±117 330±135 m, P=0.02), better cardiac function classification (2.1±0.6 2.3±0.7, P=0.01) and shorter average duration (7.3±2.5 8.9±2.1 days, P<0.001) in hospital at discharge. 1 year later, the corresponding indicators are still better than the control group, and the readmission rate (8.7% 16.0%, P=0.02) and incidence of MACCE (4.7% 11.3%, P=0.03) were lower.
The HF center model can standardize the management and improve the prognosis of patients with HF, it should be promoted actively.
心力衰竭（HF）是各种心脏病的终末期。中国已出现越来越多的HF中心，旨在促进对HF患者进行标准化、多学科和科学的管理。本研究旨在观察HF中心的建立对HF患者的标准化管理和预后是否有积极影响。
采用前后对照研究，在我院（黄石市中心医院，湖北理工学院附属医院）的HF数据库中随机收集300例病历和随访数据。参照本中心认证日期（2020年12月），选取150例纳入中心组（2021年1月至2022年12月，认证后），150例纳入对照组（2019年1月至2020年12月，认证前）。对两组进行统计学比较，重点关注标准化管理指标[用于HF诊断的N末端B型利钠肽原（NT-proBNP）和超声心动图检查的比例、血管紧张素转换酶抑制剂（ACEI）/血管紧张素受体阻滞剂（ARB）/血管紧张素受体脑啡肽酶抑制剂（ARNI）的应用率、射血分数降低的心力衰竭（HFrEF）患者中β受体阻滞剂的应用率、出院后1周、1个月、3个月和1年的随访率]以及临床预后指标（出院时NT-proBNP水平、6分钟步行距离试验、心功能分级、平均住院时间缩短），1年后复查相关指标、再入院率和1年内心血管和脑血管主要不良事件（MACCE）的发生率。
与对照组相比，中心组出院前使用NT-proBNP的患者比例（94.7%对87.3%，P=0.03）、超声心动图检查比例（88.7%对78.7%，P=0.02）、使用ACEI/ARB/ARNI的患者比例（87.0%对72.2%，P=0.03）和β受体阻滞剂的比例（82.7%对66.7%，P=0.03），以及出院后各时间段的随访率（1周，90.7%对80.0%，P=0.01；1个月，84.7%对72.0%，P=0.01；3个月，76.7%对64.0%，P=0.02；1年，88.0%对79.3%，P=0.04）更高。经过标准化管理，中心组患者出院时NT-proBNP水平较低（1760±934对2279±1085 pg/mL，P＜０.００１），6分钟步行试验距离更远（364±117对３３０±135 m，P=0.02），心功能分级更好（2.1±0.6对2.3±0.7，P=0.01），平均住院时间更短（7.3±2.5对8.9±2.1天，P＜０.００１）。1年后，相应指标仍优于对照组，再入院率（8.7%对16.0%，P=0.02）和MACCE发生率（4.7%对11.3%，P=0.03）更低。
HF中心模式可规范HF患者的管理并改善其预后，应积极推广。
