| Objective : This paper intends to study the influence of standardized treatment of heart failure center on the prognosis of patients with chronic heart failure,in order to provide reference for clinical treatment of heart failure.Methods: Based on the data platform date of January 1,2020,which was filled for the first time after the Heart Failure Center of 920 th Hospital of the Joint Logistic Support Force was established,patients with heart failure hospitalized from January 1,2019 to December 31,2019 were included in the control group,and patients with heart failure hospitalized from January 1,2020 to December 31,2020 were included in the experimental group.By analyzing patients’ baseline data and past medical history retrospectively,the compliance rate in-hospital and out-of-hospital of ACEI/ARB/ARNI medication,β-blocker medication,MRA medication,SGLT-2i medication,anticoagulant medication in patients with atrial fibrillation and SGLT2 i medication in patients with diabetes were analyzed.According to the guidelines of "China Heart Failure Center Construction Standards" : HFr EF patients used ARNI / ACEI / ARB> 80% standard before discharge;Before discharge,HFr EF patients met β-blockers> 80%;Before discharge,HFr EF patients used MRA> 80%;Before discharge,HFr EF patients with SGLT 2 inhibitor> 50% reached the standard;Heart failure patients with atrial fibrillation used> 60% of anticoagulation therapy;The discharge utilization rate of SGLT 2 inhibitor in heart failure patients with diabetes reached the standard;Follow-up HFREF patients using ARNI / ACEI / ARB> 80% standard;Follow-up of HFREF patients met β blockers> 80%;Follow-up HFREF patients with MRA>80% reached standard;Follow-up HFr EF patients with SGLT 2 inhibitors> 60%reached standard;Follow-up heart failure patients with atrial fibrillation> 60%;Follow-up SGLT 2 inhibitor discharge utilization rate> 70% in HF patients with diabetes mellitus.The readmission rate at 30 days after discharge,readmission rate at 1 year,mortality at 30 days after discharge,mortality at 1 year after discharge,cardiac function at 1 year after discharge(LVEDD,EF,BNP,6min walking distance)were followed up.Results:(1)In this study,a total of 216 patients meeting the criteria were included in the control group and 298 patients meeting the criteria in the experimental group.There was no statistical difference in the baseline data and past medical history between the two groups,suggesting that baseline clinical data and past medical history would not affect the subsequent comparison of therapeutic effects between the two groups.(2)The comparison of the baseline examination indicators on admission between the two groups showed that there were no statistical differences in heart rate,systolic blood pressure,diastolic blood pressure,sodium,potassium,creatinine,e-GFR,BNP,LVEDD and EF between the two groups on admission(P > 0.05),suggesting that the baseline indicators on admission did not affect the subsequent comparison of treatment effect between the two groups.(3)The in-hospital compliance rate of ACEI/ARB/ARNI,β-blocker,MRA,SGLT-2i,anticoagulant drugs in patients with atrial fibrillation and SGLT2 i in patients with diabetes in the experimental group was significantly higher than that in the control group.The difference was statistically significant(P < 0.05),and the compliance rate of MRA in the experimental group did not reach the standard of heart failure center,which should be noted.(4)The out-of-hospital compliance rate of ACEI/ARB/ARNI,β-blocker,MRA,SGLT-2i,anticoagulant drugs in patients with atrial fibrillation,and SGLT2 i in patients with diabetes in the experimental group was significantly higher than that in the control group.The difference was statistically significant(P < 0.05).In the experimental group,the compliance rate of out-of-hospital MRA and SGLT-2i drugs did not reach the standard of heart failure center,which should be paid attention to.(5)The 1 year readmission rate,30 days after discharge mortality and 1 year after discharge mortality of the experimental group were significantly lower than the control group,the difference was statistically significant(P < 0.05).The comparison of cardiac function 1 year after discharge between the two groups showed that the level of LVEDD and BNP of the experimental group was significantly lower than that of the control group,while EF and 6min walking distance were significantly higher than that of the control group.The difference was statistically significant(P < 0.05).(6)After The Heart failure centers are certified,134 patients were treated with ACEI or ARB and completed follow-up,and 152 patients were treated with ARNI and completed follow-up.Comparing the cardiac function indexes of the two groups one year later,the level of LVEDD and BNP in patients treated with ARNI was significantly lower than that in patients treated with ACEI or ARB.EF and 6min walking distance were significantly higher than those in ACEI or ARB treatment groups,the difference was statistically significant(P < 0.05),suggesting that the effect of ARNI in the treatment of heart failure was significantly better than that in ACEI or ARB treatment groups.Conclusion:(1)The Heart failure centers are certified in our hospital,and the management system of diagnosis,treatment and follow-up has been established.It has also been proved that The Heart failure centers are certified can greatly improve the standard rate of in-hospital and out-of-hospital drug use of patients.(2)The Heart failure centers are certified by using ARNI to treat patients with chronic heart failure,the improvement of cardiac function and exercise tolerance of patients is more obvious,and the effect is better than that of ACEI or ARB treatment.The long-term prognosis and cardiac function improvement of patients with chronic heart failure are more obvious,and ARNI is more recommended to treat patients with chronic heart failure. |
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