2020 中国心力衰竭医疗质量控制报告

2020 Clinical Performance and Quality Measures for Heart Failure in China

心力衰竭(心衰)是各种心脏疾病的严重和终末阶段,已经成为影响我国居民健康的重要公共卫生问题。针对目前我国心衰规范化诊治方面存在的问题,积极开展心衰医疗质量评价和改进,提高心衰诊治的规范性,具有重要的意义。自从2018年3月成立国家心血管病中心心力衰竭专病医联体(HFMU-NCCD),加入医院已超过1000家。国家心血管病医疗质量控制中心专家委员会心力衰竭专家工作组(NCCQI-HF)纳入2017~2020年期间在医联体单位住院的心衰患者,开展全国心衰医疗质量评价,包括心衰的诊断与评估、指南指导的药物治疗及器械治疗、临床结局等,并依据该研究结果和我们的思考,撰写成本报告。此外,通过与China-HF注册研究(2012~2015年)结果及美国心脏学会(AHA)的“跟着指南走——心力衰竭(GWTG-HF)”项目结果做比较,发现当前我国在心衰诊疗规范化方面较以前有明显改善,但仍存在诊疗不足、治疗不当及治疗过度等现象,不同等级医院之间也存在差异,而且与美国比较仍有一定差距,也体现出心衰患者特点以及国情的不同。未来需要提高数据填报数量和质量,持续开展医疗质量控制和改进,以便从整体上提高我国心衰的诊治水平。

Heart failure(HF)is the advanced manifestation of various heart diseases and has become an important public health problem affecting Chinese adult residents.In view of the problems existed in the standardization on the diagnosis and treatment of HF in China,it is of great significance to actively carry out the medical quality evaluation of HF,and improve national standardization of diagnosis and treatment of HF.Since the establishment of the Heart Failure Medical Union of the National Center for Cardiovascular Diseases(HFMU-NCCD)in March 2018,more than 1000 hospitals all over the country have participated in the HFMU-NCCD.Based on the data from patients hospitalized with HF from 2017 January to 2020 October in hospitals participating HFMU-NCCD nationwide,the Working Group on Heart Failure of National Center for Cardiovascular Quality Improvement(NCCQI-HF)performed national medical quality evaluation for HF,including the diagnosis and assessment of HF,evidenced-based medical therapy and device therapy,and clinical outcomes,etc,and this report is written.Compared to China-HF Registry,the standardization of diagnosis and treatment of HF has remarkably improved in China,though there are still some limitations on clinical performances such as under-treatment and over-treatment as well as substantial variation among hospitals of different levels across the country.Moreover,there is still a certain gap in clinical performances in China at present in comparison with the Get With The Guideline-Heart Failure(GWTG-HF)program overseen by the American Heart Association(AHA),which may to some extent attribute to the differences in the characteristics of patients with HF and national condition.Thus,it is necessary to improve the quantity and quality of data filling in the future,and to carry out medical quality control and improvement continuously,so as to improve the diagnosis and treatment of HF in China as a whole.