“射血分数低于50%”警示对非心脏科医师诊疗心衰患者的影响  

Impact of the warning label“Ejection Fraction<50%”on the management of heart failure patients in non-cardiac specialists

作　　者：陈巧玮 林嘉仪 唐思琪 亢玉[1] 张庆[1] CHEN Qiaowei;LIN Jiayi;TANG Siqi;KANG Yu;ZHANG Qing(Department of Cardiology,West China Hospital,Sichuan University,Chengdu 610014,China;Department of Cardiology,Xiamen Cardiovascular Hospital Affiliated to Xiamen University,Xiamen 361004,Fujian,China;Department of Internal Medicine,Peking Union Medical College Hospital,Beijing 100032,China)

机构地区：[1]四川大学华西医院心脏内科,四川成都610041 [2]厦门大学附属心血管病医院心脏内科,福建厦门361004 [3]北京协和医院内科,北京100032

出　　处：《西部医学》2022年第11期1624-1629,共6页Medical Journal of West China

基　　金：四川大学华西医院135卓越计划(2020HXFH045);四川省科技计划项目(2017SZ005)。

摘　　要：目的探讨超声心动图报告上增加“射血分数(LVEF)低于50%”警示标记,能否提高非心脏科医师对心力衰竭(HF)患者的关注度并提高诊疗质量。方法连续纳入2018年1~6月在非心脏科住院且超声心动图LVEF<50%的患者,在其报告上加盖“射血分数低于50%”警示标记作为标记组(n=359)。回顾性纳入2017年1~6月相似的住院患者作为未标记组(n=367)。从医院信息系统中提取患者的人口学数据和临床资料,并通过该系统记录非心脏科医师是否有HF诊疗行为,包括HF诊断、N端脑利钠肽前体(NT-proBNP)检测、心脏科会诊、心脏科门诊推荐、指南推荐的药物治疗和心脏科门诊就诊。对比两组间HF患者接受诊疗行为差异。并根据HF分型、住院科室及是否接受心内科会诊对患者进行分组并对比两组患者间的差异。结果标记组与未标记组相比,心脏科会诊率和心脏科门诊推荐率更高(P<0.05),但两组间HF诊断率、NT-proBNP检测率、指南推荐的药物治疗使用率以及心脏科门诊就诊率均无差异(P>0.05)。根据LVEF减低程度将HF患者分为LVEF轻度减低(40%~50%)的心衰组(HFmrEF组)和LVEF减低(<40%)的心衰组(HFrEF组)。在HFmrEF组中,标记组心脏科会诊率和心脏科门诊推荐率高于未标记组(P<0.05),而在HFrEF亚组中无统计学差异(P>0.05)。Logistic回归分析发现“射血分数低于50%”警示标记是增加心脏科会诊可能性的独立因素(OR=1.45,P=0.02)。结论超声心动图报告上“射血分数低于50%”警示标记可提高非心脏科医师对HF,尤其是HFmrEF患者的关注度,提高心脏科会诊率和心脏科门诊推荐率。Objective The study aimed to evaluate the impact of the warning label“Ejection Fraction(LVEF)<50%”on the delivery of care to heart failure(HF)patients in non-cardiology settings.Methods Non-cardiac inpatients underwent echocardiography from January to June 2018 were prospectively enrolled,with a warning label stating“Ejection Fraction<50%”added on echocardiography reports if they had LVEF of<50%(Labeled group).A similar group of patients retrospectively recruited from January to June 2017 were as the control group(Unlabeled group).HF-related management during hospitalization collected by hospital information system were compared between the two groups,including the rates of HF diagnosis,N-terminal-pro-B-type natriuretic peptide(NT-proBNP)testing,in-hospital cardiology consultation,referral to a cardiology clinic,prescription of HF guideline directed medical therapy and cardiology clinic visit.All patients were subdivided into HF with mildly-reduced LVEF(40%~50%,HFmrEF)and HF with reduced LVEF(<40%,HFrEF)within the Labeled and Unlabeled group.Similarly,we subdivided subjects into’Medical’and’Surgical’as per their admission specialties and whether they received in-hospital cardiology consultation.Results Compared to the unlabeled group,the labeled group had a higher rate of referral to a cardiology clinic and requests for cardiology consultation.No difference was found in the rate of HF diagnosis,request for NT-proBNP testing,guideline directed medical therapy and cardiology clinic visit.The Labeled group had higher rate of cardiology consultation and referral to a cardiology clinic was significant in HF patients with LVEF 40%~50%(HFmrEF)(P<0.05),but not in HF patients with LVEF<40%(HFrEF).By Logistic regression analysis,the Warning Label was independently associated with an increased odds ratio for cardiology consultation(OR=1.45,P=0.02).Conclusion The warning label enhanced the specialist intervention for HF patients treated in non-cardiology settings,especially in the patients with mildly-reduced

关 键 词：心力衰竭 超声心动图 射血分数 诊断 治疗 

分 类 号：R541.6[医药卫生—心血管疾病]