부산대학교 도서관

Introduction:Although quality improvement interventions for acute heart failure have been studied in high-income countries, none have been studied in low-and middle-income country settings where the baseline quality of care is often worse.Methods:We evaluated the effect of a locally-contextualized quality improvement toolkit on process of care measures and clinical outcomes in patients hospitalized for acute heart failure in 8 hospitals in Kerala, India from February 2018 to August 2018 utilizing a time interrupted series design. The toolkit included discharge checklists, personalized audit-and-feedback, and patient education materials. The primary outcome was rate of guideline-directed medical therapy for patients with heart failure with reduced ejection fraction (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, beta-blocker, and aldosterone antagonist) at the time of discharge. We used logistic regression and autoregressive integrated moving average models for analysis.Results:Among 1400 participants, mean (SD) age was 66.6 (12.2) years, and 38% were female. Mean (SD) left ventricular ejection fraction was 35.2% (9.7%). The Tableshows the difference in outcomes during the control and intervention periods. The primary outcome was observed in 41.3% of the intervention group and 28.1% of the control group (difference 13.2%; 95% CI 6.8, 19.0; adjusted OR = 1.7; 95% CI 1.17, 2.48). There were improvements in discharge process of care measures of diet counseling, weight monitoring instructions, and scheduling of outpatient clinic follow-up but not hospital length of stay nor inpatient mortality.Conclusions:A locally-contextualized quality improvement toolkit increased guideline-directed medical therapy in Kerala. Broader implementation of this quality improvement intervention may improve heart failure care in low- and middle-income countries.