Guideline-directed medical therapy utilization in patients with heart failure with reduced ejection fraction (HFrEF) remains low despite benefits in morbidity and mortality. The authors describe a unique quality improvement initiative designed to increase angiotensin receptor-neprilysin inhibitor (ARNI) and mineralocorticoid receptor antagonist (MRA) utilization in outpatients with HFrEF in a large cardiology practice, whereby eligible patients were identified in a standardized review process and medication utilization rates were linked to group quality metrics. Eligible HFrEF patients were defined as having a left ventricular ejection fraction (LVEF) ≤40% and NYHA functional class II to IV level of symptoms. Those with an LVEF >40%, no documented LVEF, or with NYHA functional class I symptoms were excluded. ARNI utilization was defined as any dose of sacubitril/valsartan prescribed, and MRA utilization was defined as any dose of either spironolactone or eplerenone prescribed. Group quality metric targets were set at >25% ARNI prescription and >60% MRA prescription in eligible patients. Following project implementation, ARNI utilization rose from 31% to 67% and MRA increased from 28% to 66%. Establishing clear quality metrics and formulating a proactive evaluation process was associated with a significant increase in prescription rates.

中文翻译：

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增加 GDMT 在射血分数降低的心力衰竭患者中使用的新举措


尽管射血分数降低的心力衰竭 (HFrEF) 患者的指南指导药物治疗在发病率和死亡率方面有所改善，但其利用率仍然较低。作者描述了一项独特的质量改进计划，旨在增加大型心脏病学诊所中 HFrEF 门诊患者血管紧张素受体脑啡肽酶抑制剂 (ARNI) 和盐皮质激素受体拮抗剂 (MRA) 的使用，通过标准化审查流程和药物使用来确定符合条件的患者比率与团体质量指标相关。符合资格的 HFrEF 患者被定义为左心室射血分数 (LVEF) ≤ 40% 且症状符合 NYHA 功能分级 II 至 IV 级。 LVEF >40%、无 LVEF 记录或具有 NYHA 功能 I 级症状的患者被排除。 ARNI 利用率被定义为沙库巴曲/缬沙坦处方的任何剂量，MRA 利用率被定义为螺内酯或依普利酮处方的任何剂量。组质量指标目标设定为合格患者的 >25% ARNI 处方和 >60% MRA 处方。项目实施后，ARNI 利用率从 31% 上升至 67%，MRA 利用率从 28% 上升至 66%。建立明确的质量指标并制定主动评估流程与处方率的显着增加相关。