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在心力衰竭住院患者中使用心脏再同步治疗
Jonathan P Piccini1, Adrian F Hernandez, David Dai
1Duke Clinical Research Institute, Durham, NC 27715, USA.
Circulation
|August 14, 2008
概括
心脏衰竭患者使用心脏再同步治疗 (CRT) 根据医院,种族和地区有很大差异,与临床试验模式不同. 需要进一步的研究和质量倡议来解决CRT治疗中的这些差异.
科学领域:
- 心脏病学 心脏病学
- 心脏衰竭管理的管理
- 医疗器械疗法 医疗器械疗法
背景情况:
- 心脏再同步治疗 (CRT) 是一种基于证据的治疗心力衰竭的方法.
- 目前的使用模式和接受CRT的患者特征在指导方针整合后并不清楚.
- 了解现实世界的CRT采用对于优化患者治疗结果至关重要.
研究的目的:
- 分析接受CRT的患者的频率和特征.
- 确定影响心力衰竭患者CRT植入的因素.
- 将现实世界的CRT使用与已建立的临床试验数据和指导方针进行比较.
主要方法:
- 分析了33898名来自美国心脏协会Get With the Guidelines-Heart Failure计划 (2005-2007) 的心力衰竭患者.
- 包括228家医院,以捕捉不同的患者群体和治疗实践.
- 统计分析以确定与CRT接收相关的患者人口统计,并发病症和治疗变异.
主要成果:
- 12.4%的患者 (4201) 用CRT活着出院,其中包括811个新植入物.
- 接受CRT的患者年龄较大,射出率较低,并患有诸如缺血性心肌病和心房动等并发症.
- 根据医院,地理区域 (东北),种族 (黑人) 以及患者年龄和射出分数,观察到新的CRT植入率的显著变化.
结论:
- 现实世界的CRT使用模式与临床试验和指导方针中观察到的不同.
- 在CRT治疗中存在显著的差异,受患者的种族,地理位置,年龄和并发症的影响.
- 需要进一步的调查和质量改进举措,以确保公平和符合指南的CRT交付.
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