Key result
Discharge checklists linked to ~27% lower 6-month mortality or HF readmission.
Why the study?
Guideline-directed medical therapy remains underutilized in patients hospitalized with acute heart failure despite its proven benefit.
Does a discharge checklist reduce all-cause mortality or HF readmission in patients hospitalized with acute heart failure?
Observational (n=724)
No
Does a discharge checklist reduce all-cause mortality or HF readmission in patients hospitalized with acute heart failure?
Effect estimate: HR 0.73 (95% CI 0.55-0.98)
Absolute Event Rate: 27.4% vs 36.4%
p-value: p=0.036
Implementation of a discharge checklist for acute heart failure patients is associated with increased GDMT prescription and reduced 6-month mortality or HF readmission, particularly in HFrEF.
May support checklist use at HF discharge; leaves open randomized confirmation of benefit.
BACKGROUND/AIMS: Despite the proven benefit of the guideline-directed medical therapy (GDMT), it remains underutilized in patients hospitalized with acute heart failure (HF). We aimed to evaluate the impact of the discharge checklist on GDMT installation and the prognosis of HF patients. METHODS: This study was a single-center, observational study that included all patients admitted for HF from March 2021 to February 2023. The data were retrieved from electronic medical records and discharge checklists. A comparison was conducted between the checklist group and the non-checklist group. The primary endpoint was a composite of all-cause mortality or readmission for HF within 6 months. RESULTS: The checklist was completed for 537 patients (checklist group) and not for 187 patients (non-checklist group). The proportion of patients to whom two or more components of GDMT were prescribed was significantly higher in the checklist group than in the non-checklist group (59.6% vs 42.2%, p < 0.001). The checklist group exhibited a significantly lower primary outcome compared to the non-checklist group (27.4% vs. 36.4%, HR 0.73, 95% CI 0.55-0.98, p = 0.036). The effect of the checklist was more prominent in HF with reduced ejection fraction (HR 0.51, 95% CI 0.34-0.77, p = 0.001) than in HF with mildly-reduced and preserved ejection fraction (HR 0.91, 95% CI 0.58-1.42, p = 0.676) (p for interaction = 0.06). CONCLUSION: The implementation of the discharge checklist was associated with an improvement in GDMT prescription and an improved prognosis in patients with HF with reduced ejection fraction.
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Lee et al. (2024) conducted an observational in Heart failure (n=724). Discharge checklist vs. No discharge checklist was evaluated on Composite of all-cause mortality or readmission for heart failure within 6 months (HR 0.73, 95% CI 0.55-0.98, p=0.036). The use of a discharge checklist reduced 6-month all-cause mortality or heart failure readmission by 27% (HR 0.73) compared to no checklist in patients hospitalized for heart failure.
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