Key result
Study assesses polypill eligibility and discharge GDMT prescription rates in South Indian HFrEF patients.
Why the study?
Hospital-based quality improvement initiatives to increase GDMT rates at discharge in patients with HFrEF have had limited effect. While HFrEF polypills have been proposed to simplify treatment, their potential effect on increasing GDMT rates and patient eligibility in target populations is unknown.
Observational
Yes
Interrupted time series study evaluates polypill eligibility in heart failure with reduced ejection fraction, highlighting strategies to improve treatment rates.
The vanguard heart failure (HF) registry in India demonstrated significantly lower 5year mortality rates for patients with HF with reduced ejection fraction (HFrEF) discharged on guidelinedirected medical therapy (GDMT), revealing an important target for intervention to improve clinical outcomes.1 Hospitalbased quality improvement initiatives to increase rates of GDMT at hospital discharge have had limited effect, suggesting additional strategies are needed to improve GDMT rates in patients with HFrEF.2 Polypills for HFrEF have been proposed as an implementation strategy to simplify the current treatment paradigm for undertreated patients with HFrEF.3 However, the potential effect of HFrEF polypills on increasing GDMT rates in target populations is unknown. The objective of this secondary analysis of a prospective, interrupted times series study is to describe eligibility for a potential HFrEF polypill in the context of GDMT prescription rates for patients with HFrEF who were discharged from 8 hospitals in South India. The HF QUIK (Heart Failure Quality Improvement in Kerala) study was a prospective, interrupted time series study using longitudinal data from February 2018 to August 2018 that evaluated the effect of a quality improvement intervention on process of care measures and clinical outcomes in patients hospitalized with acute HF in 8 hospitals in South India.4 Patients were eligible for inclusion if they were (1) adults aged ≥18 years, and (2) met at least 2 criteria for diagnosis of HF as defined by the European Society of Cardiology (clinical symptoms and signs of HF, natriuretic peptide elevation, or echocardiographic evidence of left ventricular systolic or diastolic dysfunction). The HF QUIK quality improvement intervention consisted of checklists, audit and feedback reports with sitespecific performance measures, and patient education materials. The control period consisted of usual care according to local hospital practice. Participants were allocated to the control (February 2018 to May 2018) or intervention period (May 2018 to August 2018) based on hospital admission date. The study protocol was reviewed by and received ethics board approval from Duke University (Durham, NC), Centre for Chronic Disease Control (New Delhi, Delhi, India), Cardiological Society of IndiaKerala Chapter (Kochi, Kerala, India), and Indian Health Ministry Screening Committee (New Delhi, Delhi, India) in November 2017. Because data were used at the local hospitals for the purpose of quality improvement, sites were granted a waiver of informed consent under the Common Rule. The data
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Vijay et al. (2021) conducted an observational in Heart failure with reduced ejection fraction (HFrEF). HF QUIK quality improvement intervention (checklists, audit and feedback reports, and patient education materials) vs. Usual care according to local hospital practice was evaluated on Eligibility for a potential HFrEF polypill in the context of GDMT prescription rates at hospital discharge. Polypill eligibility and GDMT prescription rates for patients with HFrEF discharged from 8 hospitals in South India were evaluated, though results are omitted from the truncated text.
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