在严重心力衰竭和减少喷射率的指导方针导向医学治疗:来自HELP-HF注册表的分析
Daniela Tomasoni1,2, Matteo Pagnesi1, Giada Colombo1
1Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
European journal of heart failure
|November 7, 2023
概括
在先进心力衰竭 (HF) 患者中,指南导向医疗疗 (GDMT) 的使用是有限的,患者的排泄分数减少 (HFrEF). 尽管如此,β抑制剂 (BB) 和ACEi/ARB/ARNI治疗与更好的结果有关,这表明治疗不足可能是由于临床惯性.
科学领域:
- 心脏病学 心脏病学
- 心脏衰竭研究研究
- 药物治疗 药物治疗
背景情况:
- 晚期心力衰竭与减少喷射率 (HFrEF) 往往呈现持久的症状,尽管指南导向医学治疗 (GDMT).
- 这些患者使用GDMT,剂量和预后影响的真实数据很少.
研究的目的:
- 评估GDMT在高级HFrEF患者中的实际使用,剂量和预后意义.
- 确定导致该人群中GDMT处方不足和剂量不足的因素.
主要方法:
- 对一个多中心注册表的分析,包括连续699名患有HFrEF和高级HF标志物的患者.
- 对β抑制剂 (BB),ACE抑制剂/血管新生素受体抑制剂/血管新生素受体-尼普利辛抑制剂 (ACEi/ARB/ARNI) 和矿物质皮质类受体对抗剂 (MRA) 的处方率和达到≥50%的目标剂量的评估.
主要成果:
- 对BB的GDMT处方率为82%,ACEi/ARB/ARNI为55%,MRA为60%,只有41%,22%和56%的患者分别达到≥50%的目标剂量.
- 低剂量的常见原因包括低血压,胸肌梗塞,功能障碍和高胆血症,但未知原因占病例的55%.
- 使用BB和ACEi/ARB/ARNI与死亡或HF住院的风险降低有关 (aHR分别为0.63和0.74).
结论:
- 在严重的HFrEF患者中,GDMT的处方和升级仍然是有限的,HFrEF患者具有先进的HF标志物.
- 很大一部分患者没有得到足够的治疗,可能是由于医疗保健专业人员或患者的临床惯性.
- 用BB和ACEi/ARB/ARNI治疗与改善生存率和减少住院病例有关,这凸显了优化GDMT的重要性.
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