PMID- 36178015 OWN - NLM STAT- MEDLINE DCOM- 20230125 LR - 20230201 IS - 2055-5822 (Electronic) IS - 2055-5822 (Linking) VI - 10 IP - 1 DP - 2023 Feb TI - Effects of multifaceted optimization management for chronic heart failure: a multicentre, randomized controlled study. PG - 133-147 LID - 10.1002/ehf2.14170 [doi] AB - AIMS: In recent years, we have developed the concept of 'clinical pathway based on integrated traditional Chinese and western medicine for the management of Chronic heart failure (CHF)'. The purpose of this study was to assess the implementation effects of multifaceted optimization management of chronic heart failure. METHODS: A total of nine physicians in optimization group from nine research sites received multifaceted intervention (a 1-day training session on how to implement the optimization programme, a written optimization programme for CHF management, supervision from daily quality coordinator, and 1-monthly monitoring and feedback of performance measure) with respect to the management of CHF, comparing to nine physicians in control group who did not receive the aforementioned multifaceted intervention and diagnosed and treated CHF patients with conventional programme (usual care). After that, a total of 256 patients with CHF were enrolled and randomly assigned to receive optimization programme [integration of usual care and traditional Chinese medicine (TCM) treatment] or conventional programme (usual care) for the treatment of CHF. The primary outcome was the change in New York Heart Association (NYHA) functional classification during 24 weeks of treatment. RESULTS: When compared with usual care, multifaceted optimization management resulted in superior improvements in NYHA functional classification at the 12-week visit (P = 0.023), the 16-week, 20-week, and 24-week visits (P < 0.001). It also demonstrated superior performance in comparison with the conventional programme with respect to readmission rate for major adverse cardiovascular events (MACEs), readmission rate for worsening heart failure, plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) level, left ventricular ejection fraction (LVEF), patient TCM syndrome scores, quality of life, and patients with heart failure with reduced ejection fraction (HFrEF) in optimization group more likely received beta-blockers and ACE inhibitors or ARBs than those in control group (P = 0.038 and P = 0.013, respectively). CONCLUSIONS: It is likely that the multifaceted optimization programme used in this study is feasible would benefit patients with CHF in NYHA functional classification, readmission for worsening heart failure, plasma NT-proBNP level, LVEF, patient TCM syndrome scores, and quality of life. Additionally, it would improve hospital personnel adherence to evidence-based performance measures for HFrEF. CI - (c) 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. FAU - Pan, Guangming AU - Pan G AUID- ORCID: 0000-0002-7601-6389 AD - Guangdong Provincial Hospital of Chinese Medicine; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China. FAU - Ji, Weiqiang AU - Ji W AUID- ORCID: 0000-0001-7058-0635 AD - The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China. FAU - Wang, Xia AU - Wang X AD - Guangdong Provincial Hospital of Chinese Medicine; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China. FAU - Li, Song AU - Li S AD - Guangdong Provincial Hospital of Chinese Medicine; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China. FAU - Zheng, Chaoyang AU - Zheng C AD - Guangdong Provincial Hospital of Chinese Medicine; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China. FAU - Lyu, Weihui AU - Lyu W AD - Guangdong Provincial Hospital of Chinese Medicine; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China. FAU - Feng, Xiaoyan AU - Feng X AD - Yangjiang Hospital of Traditional Chinese Medicine, Yangjiang, Guangdong, China. FAU - Xia, Yu AU - Xia Y AD - Qingyuan Hospital of Traditional Chinese Medicine, Qingyuan, Guangdong, China. FAU - Xiong, Zhihua AU - Xiong Z AD - Guangzhou Baiyun Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China. FAU - Shan, Haohong AU - Shan H AD - Guangzhou Zengcheng District Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China. FAU - Yang, Haiyu AU - Yang H AD - Jiangmen Wuyi Hospital of Traditional Chinese Medicine, Jiangmen, Guangdong, China. FAU - Zou, Xu AU - Zou X AUID- ORCID: 0000-0002-6489-6227 AD - Guangdong Provincial Hospital of Chinese Medicine; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China. LA - eng GR - YN2015MS10/Specific Research Fund for TCM Science and Technology of Guangdong Provincial Hospital of Chinese Medicine/ GR - Studio of Lingnan Deng's Internal Medicine School and the Studio of Xu Zou, Guangdong Provincial Famous Doctor of TCM/ PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial DEP - 20220930 PL - England TA - ESC Heart Fail JT - ESC heart failure JID - 101669191 RN - 0 (Angiotensin Receptor Antagonists) RN - 0 (Angiotensin-Converting Enzyme Inhibitors) SB - IM MH - Humans MH - *Heart Failure MH - Stroke Volume MH - Quality of Life MH - Angiotensin Receptor Antagonists/therapeutic use MH - Ventricular Function, Left MH - Angiotensin-Converting Enzyme Inhibitors/therapeutic use MH - Chronic Disease PMC - PMC9871673 OTO - NOTNLM OT - Chronic heart failure OT - Implementation OT - Optimization OT - Randomized controlled trial OT - Traditional Chinese medicine COIS- The authors declare that they have no competing interests. EDAT- 2022/10/01 06:00 MHDA- 2023/01/26 06:00 PMCR- 2022/09/30 CRDT- 2022/09/30 06:13 PHST- 2022/09/01 00:00 [revised] PHST- 2022/03/01 00:00 [received] PHST- 2022/09/15 00:00 [accepted] PHST- 2022/10/01 06:00 [pubmed] PHST- 2023/01/26 06:00 [medline] PHST- 2022/09/30 06:13 [entrez] PHST- 2022/09/30 00:00 [pmc-release] AID - EHF214170 [pii] AID - 10.1002/ehf2.14170 [doi] PST - ppublish SO - ESC Heart Fail. 2023 Feb;10(1):133-147. doi: 10.1002/ehf2.14170. Epub 2022 Sep 30.