Nationwide implementation of heart failure therapies: National Heart Failure Center Accreditation Program (HF-CAP) in China
Jingmin Zhou1, Xuejuan Jin2, Yamei Xu1
1Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.
Insights
Implementing guideline-directed medical therapy for heart failure (HF) is achievable nationwide. This large-scale study shows HF-CAP accreditation significantly reduced HF readmissions and cardiovascular death, demonstrating clear cardiovascular benefits.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Implementing optimal guideline-directed medical therapy (GDM) for heart failure (HF) remains a significant clinical challenge.
- Large-scale, nationwide initiatives are crucial for improving HF patient outcomes.
Purpose of the Study:
- To assess the benefits of a multi-annual, nationwide implementation of HF therapies in China.
- To evaluate the impact of the National Heart Failure Center Accreditation Program (HF-CAP) on patient outcomes.
Main Methods:
- Prospective, longitudinal study with a pre-post comparison design.
- Included 408,073 patients with HF from 646 centers accredited by HF-CAP.
- Compared outcomes across four groups based on time relative to accreditation: Pre, Y1, Y2, and Y2+.
Main Results:
- HF-CAP accreditation was associated with increased adherence to GDM post-discharge.
- The primary endpoint (1-year composite HF readmission and/or cardiovascular death) risk significantly decreased post-accreditation (OR 0.720 in Y2+).
- HF readmission risk reduced from Y1 onwards, and cardiovascular death risk reduced from Y2 onwards. Face-to-face visits were associated with reduced cardiovascular death risk.
Conclusions:
- Nationwide implementation of GDM and follow-up post-HF hospitalization is feasible.
- HF-CAP accreditation is associated with significant and incremental cardiovascular benefits for HF patients.
- Effective follow-up strategies, particularly in-person visits, contribute to improved patient outcomes.
Aims:
Implementing optimal guideline-directed medical therapy is still challenging in patients with heart failure (HF). This prospective study assessed the benefits of large-scale, nationwide, multi-annual implementation of HF therapies in China.
Methods And Results:
This longitudinal, pre-post comparison design included patients in hospitals accredited by the National Heart Failure Center Accreditation Program (HF-CAP). Patients were divided into four groups: 6-12 months before accreditation (Pre); >0 -≤12 months after accreditation (Y1); >12-≤24 months after accreditation (Y2), and >24 months after accreditation (Y2+). The primary endpoint was 1-year composite HF readmission and/or cardiovascular death. Secondary endpoints included 1-year HF readmission alone, 1-year cardiovascular death alone, and association between phone calls and/or visits and outcomes. Overall, 408 073 patients with HF from 646 centres were included. After HF-CAP accreditation, more patients with HF were treated following discharge. Compared with the Pre group, risk of meeting the primary endpoint decreased in Y1 and was incrementally lower in Y2 and Y2+: fully adjusted odds ratios (OR) and 95% confidence intervals (CIs) were 0.893 (0.871-0.916), 0.855 (0.830-0.880) and 0.720 (0.695-0.745), respectively (all p < 0.0001). Risk of HF readmission alone reduced from Y1 onwards (OR 0.865 [95% CI 0.841-0.891]). Risk of cardiovascular death reduced from Y2 onwards (OR 0.942 [95% CI 0.904-0.983]). Phone calls had little association with patient outcomes; however, face-to-face visits reduced risk of cardiovascular death (OR 0.624 [95% CI 0.597-0.651]).
Conclusions:
Guideline-directed medical therapy implementation and follow-up after HF hospitalization was achievable in ~400 000 patients and was associated with cardiovascular benefits 1-year post-initiation.
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