Readmission Rate and Percentage of Drug used as Guideline-Directed Medical Therapy Before and After Checklist (QR Code) Implement in Heart Failure Treatment

Abstract

Background: Congestive heart failure (CHF) is a common cardiac syndrome that produces high morbidity, mortality, and rehospitalization. Nowadays, heart failure reduced ejection fraction (HFrEF) treatment as guideline directed medical therapy (GDMT) following by Thai Heart Failure Guideline 2019 has proven benefits. The authors recognized that many patients were readmitted because of improper medications. Implementing checklist before discharge might improve drug adherence and decrease hospitalization rate. Objective: Compared rehospitalization rate of CHF among patients using checklist and non-using checklist, as the primary outcome. Drug use as GDMT were also evaluated among both groups, as the secondary outcome. Materials and Methods: The present study used a retrospective cohort and compared HFrEF patients who used checklist, as intervention group, with non-using checklist, as control group. Intervention group patients were admitted between December 2020 and December 2021, whereas control group patients were admitted between December 2019 and November 2020 in Vajira Hospital. The medical records of the intervention and control groups were retrospectively reviewed at the first admission. The rehospitalization rate at one and three months were compared. The prescribed medications including angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), beta-blockers, spironolactone, and diuretics, as GDMT, before discharge were compared between groups. Results: One hundred forty-six patients were included, 56 patients in the checklist group and 90 patients in the control group. Prescription of beta-blockers was significantly higher in the checklist group compared to control group at 96.4% versus 83.3% (p=0.016). However, ACEI/ARB/ ARNI prescribed was significantly lower in checklist group at 62.5% versus 84.4% (p=0.003). Spironolactone and diuretics used was not different between the groups. The 3-month readmission rate due to CHF was significantly lower in checklist group at 17.3 persons-3-months versus 37.9 persons-3-months (p=0.035). Conclusion: The checklist, or using QR code, implementation before discharge in HFrEF patients decreased the rate of rehospitalization at three months for CHF. Checklist using increased adherence to beta-blockers but decreased prescription of ACEI/ARB/ARNI drugs.