| Impact of discharge checklist on guideline-directed medical therapy and mid-term prognosis in heart failure |
Won-Seok Lee1, Kyu-Sun Lee2, Helsi Rismiati3, and Hae-Young Lee4,5
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1Seoul National University College of Medicine, Seoul, Korea
2Division of Cardiology, Department of Internal Medicine, Daejeon Eulji University Hospital, Daejeon, Korea
3Dr. Moewardi Regional Public Hospital, Surakarta, Indonesia
4Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
5Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea |
Corresponding Author:
Hae-Young Lee , Tel: +82-2-2072-0698, Fax: +82-2-3674-0805, Email: hylee612@snu.ac.kr
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Received: March 14, 2024; Revised: July 28, 2024; Accepted: August 19, 2024. |
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| Abstract |
Background/Aims: Despite the proven benefit of the guideline-directed medical therapy (GDMT), it remains underutilized in patients hospitalized with acute heart failure (HF). We aimed to evaluate the impact of the discharge checklist on GDMT installation and the prognosis of HF patients.
Methods: This study was a single-center, observational study that included all patients admitted for HF from March 2021 to February 2023. The data were retrieved from electronic medical records and discharge checklists. A comparison was conducted between the checklist group and the non-checklist group. The primary endpoint was a composite of all-cause mortality or readmission for HF within 6 months.
Results: The checklist was completed for 537 patients (checklist group) and not for 187 patients (non-checklist group). The proportion of patients to whom two or more components of GDMT were prescribed was significantly higher in the checklist group than in the non-checklist group (59.6% vs 42.2%, p < 0.001). The checklist group exhibited a significantly lower primary outcome compared to the non-checklist group (27.4% vs. 36.4%, HR 0.73, 95% CI 0.55–0.98, p = 0.036). The effect of the checklist was more prominent in HF with reduced ejection fraction (HR 0.51, 95% CI 0.34–0.77, p = 0.001) than in HF with mildly-reduced and preserved ejection fraction (HR 0.91, 95% CI 0.58–1.42, p = 0.676) (p for interaction = 0.06).
Conclusions: The implementation of the discharge checklist was associated with an improvement in GDMT prescription and an improved prognosis in patients with HF with reduced ejection fraction. |
| Keywords:
Heart failure ; Checklist ; Prescription |
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