Compliance of the management of hospitalized patients with heart failure with the quality criteria for health care: data from the St. Petersburg registry
G. V. Endubaeva,
A. E. Solovyova,
A. E. Medvedev,
M. M. Kurbanova,
E. I. Kogan,
T. V. Gorbacheva,
A. V. Yazenok,
N. E. Zvartau,
S. V. Villevalde https://doi.org/10.15829/1560-4071-2023-5621
EDN: BBAIJN
Abstract
Aim. To assess the compliance of the management of patients with heart failure (HF) with quality criteria (QC) for health care, including discharge instructions for patients.
Material and methods. Hospitalizations of patients aged over 18 years with HF (ICD 10 code — I50.x) during the period from January 1, 2019 to October 1, 2020 were randomly selected from the "Chronic Heart Failure" registry of St. Petersburg. Discharge and post-mortem summaries were assessed for compliance with the quality criteria listed in the 2020 Russian Chronic Heart Failure guidelines.
Results. The study included 553 patients (women, 71,1%, mean age, 82,0±9 years, comorbidities: hypertension — 99,1%, coronary artery disease — 97,6%, chronic kidney disease — 53,2%, diabetes — 32,6%). Electrocardiography (QC № 1) was performed in 94,2% of patients, chest radiography (QC № 2) 91,7%, echocardiography (QC № 3) — 81,0%, but the results were not always informative. The exact ejection fraction (EF) value was reported in 55,4% of patients. Laboratory examination corresponded to QC № 4-6 in 20,3% of cases and was performed in 53,3-94,9%. Natriuretic peptides (NPs) were not determined (QC № 7-0%).
The completeness of intravenous therapy (QC № 8) was not assessed due to insufficient physical examination data.
Oral therapy (QC № 9) was prescribed frequently as follows: renin-angiotensinaldosterone system inhibitors (RAASo) — 93,3%, beta blockers (BBs) — 85,4%, mineralocorticoid receptor antagonists (MRAs) — 78,7%. However, triple RAAS+BB+MRA therapy was carried out in 54,1% of HF cases with EF <50% and no contraindications.
Diet was recommended in 87,1% of summaries, water-salt regimen — 53,3%, drug titration — 8,2%. The date of visit to outpatient cardiologist was indicated in 10,0%.
Conclusion. With the exception of NP assessment, the scope of paraclinical studies corresponded to the QC in the majority of patients. Optimal therapy was prescribed to 54,1% of patients with EF <50%. An early outpatient visit after discharge was indicated in 10,0% of summaries.
About the Authors
G. V. Endubaeva
Almazov National Medical Research Center
Russian Federation
Competing Interests:
Russian Federation
MD, Leading Specialist, Head of the Monitoring Group for the Special Presentation of Programs at the Division for the Federal Projects Implementation.
St. Petersburg
Competing Interests:
none
A. E. Solovyova
Almazov National Medical Research Center
Russian Federation
Competing Interests:
Russian Federation
MD, PhD, Associate professor at the Department of Cardiology, Faculty of Advanced Training, Institute of Medical Education, Head of the department of scientific support of staffing at the Division for the Federal Projects Implementation.
St. Petersburg
Competing Interests:
none
A. E. Medvedev
Almazov National Medical Research Center
Russian Federation
Competing Interests:
Russian Federation
MD, postgraduate student at the Department of Cardiology, Faculty of Advanced Training, Institute of Medical Education, Specialist of the Department of Drug Provision and Circulation of Medical Devices at the Division for the Federal Projects Implementation.
St. Petersburg
Competing Interests:
none
M. M. Kurbanova
Almazov National Medical Research Center
Russian Federation
Competing Interests:
Russian Federation
MD
St. Petersburg
Competing Interests:
none
E. I. Kogan
Medical Information and Analytical Center
Russian Federation
Competing Interests:
Russian Federation
main specialist.
St. Petersburg
Competing Interests:
none
T. V. Gorbacheva
Medical Information and Analytical Center
Russian Federation
Competing Interests:
Russian Federation
analyst engineer.
St. Petersburg
Competing Interests:
none
A. V. Yazenok
Medical Information and Analytical Center
Russian Federation
Competing Interests:
Russian Federation
MD, Director.
St. Petersburg
Competing Interests:
none
N. E. Zvartau
Almazov National Medical Research Centre
Russian Federation
Competing Interests:
Russian Federation
D, PhD, Deputy Director for work with regions, Head of the Division of the Federal Projects Implementation, Associate Professor at the Department of Faculty Therapy with the Clinic, Institute of Medical Education.
St. Petersburg
Competing Interests:
none
S. V. Villevalde
Almazov National Medical Research Centre
Russian Federation
Competing Interests:
Russian Federation
MD, PhD, Doctor of medical sciences, Professor, Head of the Analysis and Prospective Planning service at the Division for the Implementation of Federal Projects, Head of the Department of Cardiology, Faculty of Advanced Training, Institute of Medical Education.
St. Petersburg
Competing Interests:
none
References
1. Salah HM, Minhas AMK, Khan MS, et al. Causes of hospitalization in the USA between 2005 and 2018. Eur Heart J Open. 2021;1(1):oeab001. doi:10.1093/ehjopen/oeab001.
2. Soloveva AE, Endubaeva GV, Avdonina NG, et al. ICD-10 code-based definition of heart failure in Saint Petersburg electronic health records: prevalence, health care utilization and outcomes. Russian Journal of Cardiology. 2021;26(S3):4621. (In Russ.) doi:10.15829/1560-4071-2021-4621.
3. Maggioni AP, Dahlström U, Filippatos G, et al.; Heart Failure Association of ESC (HFA). EURObservational Research Programme: the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail. 2010;12(10):1076-84. doi:10.1093/eurjhf/hfq154.
4. Kimmoun A, Takagi K, Gall E, et al.; METAHF Team. Temporal trends in mortality and readmission after acute heart failure: a systematic review and meta-regression in the past four decades. Eur J Heart Fail. 2021;23(3):420-31. doi:10.1002/ejhf.2103.
5. Villevalde SV, Soloveva AE. Decompensated heart failure with reduced ejection fraction: overcoming barriers to improve prognosis in the "vulnerable" period after discharge. Kardiologiia. 2021;61(12):82-93. (In Russ.) doi:10.18087/cardio.2021.12.n1860.
6. Tromp J, Ouwerkerk W, van Veldhuisen DJ, et al. A Systematic Review and Network MetaAnalysis of Pharmacological Treatment of Heart Failure With Reduced Ejection Fraction. JACC Heart Fail. 2022;10(2):73-84. doi:10.1016/j.jchf.2021.09.004.
7. Mebazaa A, Davison B, Chioncel O, et al. Tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial. Lancet. 2022;400(10367):1938-52. doi:10.1016/S01406736(22)02076-1.
8. 2020 Clinical practice guidelines for Chronic heart failure. Russian Journal of Cardiology. 2020;25(11):4083. (In Russ.) doi:10.15829/1560-4071-2020-4083.
9. McDonagh TA, Metra M, Adamo M, et al.; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-726. doi:10.1093/eurheartj/ehab368.
10. Writing Committee Members; ACC/AHA Joint Committee Members. 2022 AHA/ACC/ HFSA Guideline for the Management of Heart Failure. J Card Fail. 2022;28(5):e1-e167. doi:10.1016/j.cardfail.2022.02.010.
11. Batra G, Aktaa S, Benson L, et al. Association between heart failure quality of care and mortality: a population-based cohort study using nationwide registries. Eur J Heart Fail. 2022;24(11):2066-77. doi:10.1002/ejhf.2725.
12. Murtazalieva PM, Karelkina EV, Shishkova AA, et al. Pilot project "Improvement of medical care for patients with chronic heart failure": results of the first stage. Russian Journal of Cardiology. 2018;(12):44-51. (In Russ.) doi:10.15829/1560-4071-2018-12-44-51.
13. Lopatin YuM, Nedogoda SV, Arkhipov MV, et al. Pharmacoepidemiological analysis of routine practice of management of patients with chronic heart failure in the Russian Federation. Part I. Russian Journal of Cardiology. 2021;26(4):4368. (In Russ.) doi:10.15829/1560-4071-2021-4368.
14. Bayes-Genis A, Januzzi JL, Richards AM, et al. The 'Peptide for Life' Initiative: a call for action to provide equal access to the use of natriuretic peptides in the diagnosis of acute heart failure across Europe. Eur J Heart Fail. 2021;23(9):1432-6. doi:10.1002/ejhf.2293.
15. Sitnikova MYu, Lesnikova EA, Yurchenko AV, et al. Results of 3 years work of the Russian hospital register of chronic heart failure (RUssian hoSpital Heart Failure Registry -RUS-HFR): relationship between management and outcomes in patients with chronic heart failure. Kardiologiia. 2018;58(S10):9-19. (In Russ.) doi:10.18087/cardio.2483.
16. Shavarova EK, Babaeva LA, Padaryan SS, et al. Chronic heart failure: recommendations and real clinical practice. Rational pharmacotherapy in cardiology 2016;12(6):631-7. (In Russ.) doi:10.20996/1819-6446-201612-6-631-637.
17. Polyakov DS, Fomin IV, Valikulova FYu, et al. Epidemiological program EPOCH-CHF: decompensation of chronic heart failure in real clinical practice (EPOCH-D-CHF). Journal of Heart Failure. 2016;5:299-305. (In Russ.)
18. Greene SJ, Fonarow GC, DeVore AD, et al. Titration of Medical Therapy for Heart Failure With Reduced Ejection Fraction. J Am Coll Cardiol. 2019;73(19):2365-83. doi:10.1016/j.jacc.2019.02.015.
19. Pierce JB, Ikeaba U, Peters AE, et al. Quality of Care and Outcomes Among Patients Hospitalized for Heart Failure in Rural vs Urban US Hospitals: The Get With The GuidelinesHeart Failure Registry. JAMA Cardiol. 2023;8(4):376-85. doi:10.1001/jamacardio.2023.0241.
20. Sitnikova MYu, Fedotov PA, Trukshina MA, et al. Modern principles ofdiagnosis and treatment of heart failure: textbook. SPb.: INFO-RA, 2018. 100p. (In Russ.)
21. Laborde-Casterot H, Agrinier N, Zannad F, et al. Effectiveness of a multidisciplinary heart failure disease management programme on 1-year mortality: Prospective cohort study. Medicine. 2016;95(37):e4399. doi:10.1097/MD.000000000000439.9.
22. Fomin IV, Vinogradova NG, Polyakov DS, Pogrebitskaya VA. The experience of introducing a new form of organization of medical care for patients with heart failure in the Russian Federation. Kardiologiia. 2021;61(3):42-51. (In Russ.) doi:10.18087/cardio.2021.3.n1005.
Supplementary files
- Based on the results of the analysis of discharge summary and death certificates of patients with HF, data laboratory and instrumental assessment meet the criteria for the quality of medical care in most cases, with the exception of the lack of determination of natriuretic peptides.
- Triple therapy for HF with low and moderately reduced EF, if indicated, was prescribed to only 54,1% of patients.
- An incomplete presentation of recommendations in the discharge summary was identified, including very low of proportions summaries (10%) with the data of outpatient visit after discharge (within the first 14 days).
Review
For citations:
Endubaeva G.V., Solovyova A.E., Medvedev A.E., Kurbanova M.M., Kogan E.I., Gorbacheva T.V., Yazenok A.V., Zvartau N.E., Villevalde S.V. Compliance of the management of hospitalized patients with heart failure with the quality criteria for health care: data from the St. Petersburg registry. Russian Journal of Cardiology. 2023;28(4S):5621. (In Russ.) https://doi.org/10.15829/1560-4071-2023-5621. EDN: BBAIJN
Views:
807
Email this article 