Nationwide implementation of heart failure therapies: National Heart Failure Center Accreditation Program (HF-CAP) in China.

Abstract

AIMS Implementing optimal guideline-directed medical therapy is still challenging in patients with heart failure (HF). This prospective study assessed the benefits of large-scale, nationwide, multi-annual implementation of HF therapies in China. METHODS AND RESULTS This longitudinal, pre-post comparison design included patients in hospitals accredited by the National Heart Failure Center Accreditation Program (HF-CAP). Patients were divided into four groups: 6-12 months before accreditation (Pre); >0 -≤12 months after accreditation (Y1); >12-≤24 months after accreditation (Y2), and >24 months after accreditation (Y2+). The primary endpoint was 1-year composite HF readmission and/or cardiovascular death. Secondary endpoints included 1-year HF readmission alone, 1-year cardiovascular death alone, and association between phone calls and/or visits and outcomes. Overall, 408 073 patients with HF from 646 centres were included. After HF-CAP accreditation, more patients with HF were treated following discharge. Compared with the Pre group, risk of meeting the primary endpoint decreased in Y1 and was incrementally lower in Y2 and Y2+: fully adjusted odds ratios (OR) and 95% confidence intervals (CIs) were 0.893 (0.871-0.916), 0.855 (0.830-0.880) and 0.720 (0.695-0.745), respectively (all p < 0.0001). Risk of HF readmission alone reduced from Y1 onwards (OR 0.865 [95% CI 0.841-0.891]). Risk of cardiovascular death reduced from Y2 onwards (OR 0.942 [95% CI 0.904-0.983]). Phone calls had little association with patient outcomes; however, face-to-face visits reduced risk of cardiovascular death (OR 0.624 [95% CI 0.597-0.651]). CONCLUSIONS Guideline-directed medical therapy implementation and follow-up after HF hospitalization was achievable in ~400 000 patients and was associated with cardiovascular benefits 1-year post-initiation.