专门的心衰诊所对门诊心脏病学实践中推荐疗法的实施的影响：来自改善门诊环境中基于证据的心衰治疗应用的注册研究（IMPROVE HF）的结果。

Influence of dedicated heart failure clinics on delivery of recommended therapies in outpatient cardiology practices: findings from the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF).

机构信息

Nursing Institute and Kaufman Center for Heart Failure, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.

出版信息

Am Heart J. 2010 Feb;159(2):238-44. doi: 10.1016/j.ahj.2009.11.022.

DOI:10.1016/j.ahj.2009.11.022

PMID:20152222

Abstract

BACKGROUND

National guidelines recommend heart failure (HF) disease management programs to facilitate adherence to evidence-based practices. This study examined the influence of dedicated HF clinics on delivery of guideline-recommended therapies for cardiology practice outpatients with HF and reduced left ventricular ejection fraction.

METHODS

IMPROVE HF, a prospective cohort study, enrolled 167 cardiology practices to characterize outpatient management of 15,381 patients with chronic systolic HF. Adherence to guideline-recommended HF therapies was recorded, and the presence of a dedicated HF clinic was assessed by survey. Multivariate models identified contributions to delivery of guideline-recommended HF therapies.

RESULTS

Of practices, 41.3% had a dedicated HF clinic. Practices with a dedicated HF clinic had greater adherence to 3 of 7 guideline-recommended HF therapy measures: angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (P = .02), beta-blocker (P = .025), and HF education (P = .009). After adjustment, use of a dedicated HF clinic was associated with greater conformity in 2 of 7 measures: cardiac resynchronization therapy (P = .036) and HF education (P = .005) but not angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker, aldosterone antagonist, implantable cardioverter-defibrillator therapy, and anticoagulation for atrial fibrillation.

CONCLUSIONS

Use of dedicated HF clinics varied in cardiology outpatient practices and was associated with greater use of cardiac resynchronization therapy and HF education but not other guideline-recommended therapies.

摘要

背景

国家指南建议心力衰竭（HF）疾病管理计划，以促进遵循循证实践。本研究考察了专门的 HF 诊所对具有降低的左心室射血分数的 HF 和心脏病学门诊患者的指南推荐治疗的提供的影响。

方法

改善 HF 是一项前瞻性队列研究，纳入了 167 个心脏病学实践，以描述 15381 例慢性收缩性 HF 门诊患者的管理情况。记录了对指南推荐的 HF 治疗的依从性，并通过调查评估了专门的 HF 诊所的存在。多变量模型确定了对指南推荐的 HF 治疗的提供的贡献。

结果

在实践中，41.3％设有专门的 HF 诊所。设有专门的 HF 诊所的实践对 7 项指南推荐的 HF 治疗措施中的 3 项具有更高的依从性：血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（P =.02），β受体阻滞剂（P =.025）和 HF 教育（P =.009）。调整后，使用专门的 HF 诊所与 7 项措施中的 2 项更一致：心脏再同步治疗（P =.036）和 HF 教育（P =.005），但不包括血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂，β受体阻滞剂，醛固酮拮抗剂，植入式心脏复律除颤器治疗和心房颤动的抗凝治疗。