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 at Inha University Hospital (January 2020?June 2024), involving 662 hospitalized HFrEF patients (mean age 70±15 years; 66% male; mean LVEF 30.7±6.8%). Patients were categorized into DCL and non-DCL groups based on checklist completion. The primary endpoint was a composite of all-cause mortality or heart failure hospitalization (HHF) within 6 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: 89.4% vs. 68.8%, p<0.001; beta-blockers: 85.9% vs. 71.4%, p<0.001; ARNI: 81.6% vs. 15.8%, p<0.001; SGLT2i: 49.5% vs. 11.3%, p<0.001, Figure 1), while MRA prescription rates were similar between the groups (68.9% vs. 67.7%, p=0.795). At 6 months, the DCL group exhibited a lower rate of the composite outcome (11.1% vs. 19.5%, p=0.004), primarily driven by reduced HHF (8.6% vs. 18.4%, p<0.001, Figure 2). Multivariate analysis confirmed DCL completion as an independent predictor of reduced risk for the composite outcome (HR 0.56, 95% CI 0.38?0.84, p=0.005). Conclusion: The implementation of a DCL at discharge significantly enhances GDMT optimization and improves clinical outcomes