Kardiologia polska 2017 03 29() doi 10.5603/KP.a2017.0040
BACKGROUND AND AIMS
Optimal management of heart failure (HF) patients is crucial to reduce both mortality and a number of hospital admissions, at the same time improving patients’ quality of life. The aim of the study was to assess a quality of care of hospitalized patients with HF in Poland in 2013 and compare it with the results of similar survey performed in 2005.
METHODS AND RESULTS
The presented study was conducted from April to November 2013 in a sample of 260 hospital wards in Poland, recruited by stratified proportional sampling. Similarly to the first study edition in 2005, a trained nurse contacted physicians who filled out the study questionnaires on the last five patients with HF who had been discharged from internal or cardiologic ward. HF did not have to be a major cause of hospital admission. Mean age of 1300 hospitalized patients was 72.1 years and had increased by 2.3 years since 2005. The proportion of patients classified as NYHA IV decreased from 28.5% in 2005 to 22.1% in 2013. In comparison with 2005, more patients had concomitant disorders such as hypertension (79.5% vs 71.0%), diabetes (46.2% vs 33.2%) and chronic renal failure (33.4% vs 19.4%). The access to echocardiography has improved during the last years, it was available for 98.9% of the surveyed hospital wards (93% in 2005) and it was performed during the hospitalization in 60.2% of the patients (58.8% in 2005). In 2013 NT-proBNP was accessible for 80.8% of hospital wards (12.8% in 2005) and the test was performed in 31.3% of the hospitalised patients (3.3% in 2005). ACEIs or ARBs were administered in 68.9% of HF discharged patients, β-blockers in 84.8%, MRAs in 57.9%, diuretics in 85.9% and digoxin in 23%. The respective numbers in 2005 were 85.9%; 76.0%; 65.4%; 88.9% and 38.4%. Decrease in prescription of ACEI or ARB resulted from lesser usage of these drugs in internal medicine wards (from 84.3% in 2005 to 55.6% in 2013).
In comparison to the analogous project run in 2005, an improvement in the some areas of HF treatment was observed in Polish hospitals such as accessibility to echocardiography and natriuretic peptide measurement as well as β-blockers and MRAs use. At the same time, a meaningful decrease in ACEIs or ARBs usage in internal wards was observed which might be the result of ageing of HF population and an increased number of comorbidities.