患有心力衰竭恶化,射出小部分减少的患者的治疗模式
Stephen J Greene1,2, Hanna K Gaggin3,4, Mo Zhou5
1Duke Clinical Research Institute, Durham, NC, USA.
ESC heart failure
|April 19, 2024
概括
准则导向医学治疗 (GDMT) 的使用,特别是组合治疗,在患有心力衰竭与减少喷射率 (HFrEF) 的美国患者中是不理想的. 随着时间的推移,GDMT中的差距持续存在,并且在经历心力衰竭事件恶化 (WHFE) 的患者中更为广泛.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 患有心力衰竭的患者减少排气分数 (HFrEF) 和恶化的心力衰竭事件 (WHFE) 面临高风险.
- 对于这些高风险患者,迫切需要改变疾病的疗法.
研究的目的:
- 评估HFrEF患者的治疗模式和药物决定理由.
- 为了比较WHFE和没有WHFE的患者之间的治疗使用情况.
主要方法:
- 2017-2019年电子病历的回顾性分析.
- 包括来自全国小组和盖辛格健康系统 (GHS) 的HF和射出分数 (EF) <45%的门诊患者.
- 在WHFE和参考队列之间比较指南推的药物剂量和组合疗法使用.
主要成果:
- 与全国范围的小组相比,在GHS队列中,较低比例的患者接受了指导方针推的β抑制剂,ACEI/ARB/ARNI和MRA剂量.
- 在两个队列中,三重治疗的使用率都很低 (42-44%全国,14-17%GHS).
- 在12个月的随访期间,没有指导方针指导的医疗疗 (GDMT) 的患者比例增加,特别是在WHFE队列 (14%至28%).
结论:
- 对于美国HFrEF患者使用GDMT,特别是组合疗法,存在显著的差距.
- 这些治疗差距在纵向随访期间显而易见.
- 最近出现WHFE的患者在使用GDMT时表现出特别大的缺陷.
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