Key result
Discharge checklists linked to ~55% lower 2-month readmission or mortality in HF.
Why the study?
In-hospital initiation of GDMT is recommended for HF patients but remains underutilized in real-world practice, prompting evaluation of a discharge checklist.
Does the use of a discharge checklist reduce all-cause mortality or HF rehospitalization in patients hospitalized for heart failure?
Observational (n=415)
No
Does the use of a discharge checklist reduce all-cause mortality or HF rehospitalization in patients hospitalized for heart failure?
Effect estimate: HR 0.45 (95% CI 0.23-0.92)
Absolute Event Rate: 5.3% vs 11.7%
p-value: p=0.028
Implementing a discharge checklist for hospitalized heart failure patients improves GDMT prescription rates and is associated with a significant reduction in 2-month mortality or HF rehospitalization.
May support discharge checklist use in HF; leaves open causality pending RCTs.
BACKGROUND/AIMS: Initiation of guideline-directed medical therapy (GDMT) during hospitalization is recommended for patients with heart failure (HF). However, GDMT is underutilized in real-world practice. This study evaluated the role of a discharge checklist on GDMT. METHODS: This was a single-center, observational study. The study included all patients hospitalized for HF between 2021 and 2022. The clinical data were retrieved from the electronic medical records and discharge checklist published by the Korean Society of Heart Failure. The adequacy of GDMT prescriptions was evaluated in three ways: the total number of GDMT drug classes and two types of adequacy scores. The primary endpoint was the incidence of all-cause mortality or rehospitalization due to HF within 2 months of discharge. RESULTS: Overall, the checklist was completed by 244 patients (checklist group) and was not completed in 171 patients (non-checklist group). The baseline characteristics were comparable between two groups. At discharge, a higher proportion of patients in the checklist group received GDMT than in the non-checklist group (67.6% vs. 50.9%, p = 0.001). The incidence of primary endpoint was lower in the checklist group compared to the non-checklist group (5.3% vs. 11.7%, p = 0.018). The use of the discharge checklist was associated with significantly lower risk of death and rehospitalization in the multivariable analysis (hazard ratio, 0.45; 95% confidence interval, 0.23-0.92; p = 0.028). CONCLUSION: Discharge checklist usage is a simple but effective strategy for GDMT initiation during hospitalization. The discharge checklist was associated with better outcome in patients with HF.
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Rismiati et al. (2023) conducted an observational in Heart failure (n=415). Discharge checklist vs. No discharge checklist was evaluated on Composite of readmission or all-cause mortality within 2 months of discharge (HR 0.45, 95% CI 0.23-0.92, p=0.028). The use of a discharge checklist significantly reduced the composite risk of readmission or all-cause mortality within 2 months by 55% (HR 0.45) compared to no checklist in patients hospitalized for heart failure.
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