Abstract

Objectives

Heart failure (HF) management is suboptimal in Sweden despite available evidence-based guidelines. To improve HF treatment, a comprehensive HF management program (4D project) was implemented in the Stockholm County (>2.1 million inhabitants). Design. A standardized care program centralized at five hospital-based HF clinics was implemented in 2014–2017. We registered from 2012 to 2017: (1) numbers of referrals and visits to HF clinics, (2) numbers of hospital admitted patients per million inhabitants, (3) dispensed HF medications after admission, and (4) covariate-adjusted 1-year all-cause mortality or HF readmission. Results. Yearly visits to the five HF outpatient clinics increased 3.4 times from 3,372 to 11,527. Dispensed HF drug prescriptions increased, in particular, for readmitted patients, compared to 2012 (p<.0001). Total number of hospital admitted HF patients as well as new-onset or readmitted HF patients decreased by 16, 13, and 20%, respectively (p < .0001). The combined 1-year mortality or HF readmission over the period was 48% (n = 17,124/35,880) and improved per year (HR 0.98 [0.97–0.99], p < .001) from 2012. Conclusion. A comprehensive standardized care HF management program including expanded HF clinics was associated with improved evidence-based medication, reduced HF hospitalization, and improvement of the combined outcome of 1-year mortality or HF readmission in Stockholm.

中文翻译：

---

心力衰竭管理的重组和改善的结果——4D HF 项目

摘要

目标

尽管有循证指南，但瑞典的心力衰竭 (HF) 管理并不理想。为了改善 HF 治疗，斯德哥尔摩县（> 210 万居民）实施了综合 HF 管理计划（4D 项目）。设计。2014-2017 年实施了集中在五家医院 HF 诊所的标准化护理计划。我们从 2012 年到 2017 年登记：(1) 转诊和就诊 HF 诊所的数量，(2) 每百万居民住院患者的数量，(3) 入院后分配的 HF 药物，以及 (4) 协变量调整的 1 年全因死亡率或 HF 再入院。结果。五家心力衰竭门诊的年就诊人次从 3,372 人次增加到 11,527 人次，增长了 3.4 倍。与 2012 年相比，配发的 HF 药物处方有所增加，特别是对于再入院患者（p <.0001 ）。入院的 HF 患者以及新发或再入院的 HF 患者总数分别减少了 16%、13% 和 20% ( p  < .0001)。在此期间，合并的 1 年死亡率或 HF 再入院率为 48% ( n  = 17,124/35,880)，并且 从 2012年开始逐年改善（HR 0.98 [0.97–0.99]，p < .001）。结论。 包括扩大 HF 诊所的综合标准化护理 HF 管理计划与改善循证药物治疗、减少 HF 住院以及改善斯德哥尔摩 1 年死亡率或 HF 再入院的综合结果相关。