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根据功能开始对心力衰竭患者进行医学治疗:丹麦全国性研究
Deewa Zahir Anjum1, Jarl Emanuel Strange1, Emil Fosbøl2
1Department of Cardiology, Copenhagen University Hospital, Hellerup, Denmark.
Clinical epidemiology
|July 25, 2023
概括
在患有功能障碍的患者中,心力衰竭治疗的使用率较低. 减少使用矿物质皮质类受体抗剂 (MRAs) 与脏问题有关,而其他药物使用更受年龄和脆弱的影响.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 药理学 药理学是指药理学的学科.
背景情况:
- 对于中度功能障碍的心力衰竭 (HF) 患者的医疗治疗使用率显著低.
- 临床医生不愿在老年和虚弱的患者处方HF疗法可能是一个关键因素,而不是单独的功能障碍.
研究的目的:
- 为了调查功能障碍,年龄,脆弱性和开始心力衰竭治疗之间的联系.
- 确定患有功能障碍的患者减少HF治疗的使用主要是由功能或患者的特征,如年龄和虚弱等驱动.
主要方法:
- 从全国范围的注册表 (2014-2021) 中确定了42320名心力衰竭患者的现实世界队列.
- 收集了估计的淋巴膜过率 (eGFR),虚弱状态和HF治疗处方的数据.
- 多变量考克斯模型被用来分析eGFR,年龄和虚弱与HF治疗开始的关联.
主要成果:
- 观察到矿物质皮质类受体对抗剂 (MRA) 的启动减少,功能下降,不论年龄和脆弱.
- 在严重的功能障碍中,宁-血管酶系统抑制剂 (RASi) 的启动显着较低,在中度功能障碍中,主要由年龄/虚弱驱动.
- 在中度功能障碍中,β-阻断剂 (BB) 的启动并没有显著降低,主要是由中度和严重功能障碍中的年龄和脆弱性解释的.
结论:
- 中度和严重的功能障碍与HF患者的MRA使用减少有关,无论年龄和脆弱性如何.
- 减少RASi的使用与严重的功能障碍有关,而年龄和虚弱主要导致中度功能障碍的使用减少.
- 年龄和虚弱似乎是降低贝塔抑制剂在患有功能障碍的HF患者使用的主要驱动因素.
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