A heart failure center model helped to promote the standardized management and improve the prognosis of patients.

Abstract

Background: 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.

Methods: 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.

Results: Compared to the control group, the proportion of patients using NT-proBNP (94.7% vs. 87.3%, P=0.03), echocardiography (88.7% vs. 78.7%, P=0.02), the ratio of patients using ACEI/ARB/ARNI (87.0% vs. 72.2%, P=0.03) and β-blocker (82.7% vs. 66.7%, P=0.03) before discharge, and the follow-up rate of each period after discharge (1 week, 90.7% vs. 80.0%, P=0.01; 1 month, 84.7% vs. 72.0%, P=0.01; 3 months, 76.7% vs. 64.0%, P=0.02; 1 year, 88.0% vs. 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 vs. 2,279±1,085 pg/mL, P<0.001), a further 6-minute walking test distance (364±117 vs. 330±135 m, P=0.02), better cardiac function classification (2.1±0.6 vs. 2.3±0.7, P=0.01) and shorter average duration (7.3±2.5 vs. 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% vs. 16.0%, P=0.02) and incidence of MACCE (4.7% vs. 11.3%, P=0.03) were lower.

Conclusions: The HF center model can standardize the management and improve the prognosis of patients with HF, it should be promoted actively.