Using a discharge checklist can improve the utility of guideline-directed medical therapy and clinical outcomes in patients with heart failure

초록

Background: Guideline-directed medical therapy (GDMT) is a cornerstone in managing heart failure with reduced ejection fraction (HFrEF). However, its adoption in real-world clinical practice remains suboptimal. Objective: This study evaluated whether implementing a discharge checklist (DCL) could optimize GDMT prescription rates and improve clinical outcomes in HFrEF patients. Methods: A single-center observational study was conducted (January 2020?June 2024), involving 690 hospitalized HFrEF patients (mean age 70±15 years; 67% male; mean LVEF 30.8±6.7%). Patients were categorized into DCL (N=394) and non-DCL groups (N=296) based on their completion of the checklist. The primary endpoint was a composite of all-cause mortality or heart failure hospitalization (HHF) within 12 months, analyzed using Kaplan-Meier estimates and multivariate Cox regression. Results: GDMT prescription rates were significantly higher in the DCL group compared to the non-DCL group for most therapies (RAS blockade: 90.1% vs. 69.6%, p<0.001; ARNI: 82.0% vs. 19.6%, p<0.001; beta-blockers: 86.3% vs. 72.3%, p<0.001; SGLT2i: 51.0% vs. 12.5%, p<0.001, Figure 1), while MRA prescription rates were similar between the groups (69.5% vs. 66.9%, p=0.510). The modified HF Collaborator (mHFC) score, which quantifies the use and dosing of key GDMT components, was significantly higher in the DCL group (5.9±2.3 vs. 3.6±2.0, p<0.001). At 12 months, the DCL group exhibited a lower rate of the composite outcome (14.5% vs. 24.7%, p=0.001), primarily driven by reduced HHF (11.2% vs. 23.0%, p<0.001, Figure 2). Multivariate analysis confirmed DCL completion as an independent predictor of reduced risk for the composite outcome (HR 0.52, 95% CI 0.37?0.875, p=0.003). Conclusion: Implementation of a DCL at discharge significantly improves GDMT optimization and reduces adverse clinical outcomes, highlighting its role in the routine care of patients with HFrEF.