老年心力衰竭患者的药物治疗和结果:来自前性队列研究的结果
David Peter Garay1, Hugo Saner2, Jan Herzberg1
1Department of Cardiology, Kantonsspital Olten and Bürgerspital Solothurn, Solothurner Spitäler AG, 4500 Solothurn, Switzerland.
Pharmaceuticals (Basel, Switzerland)
|June 27, 2024
概括
在瑞士,针对老年急性心力衰竭 (AHF) 患者的指南导向医学治疗 (GDMT) 在出院和再入院时不理想. 现实世界的数据显示预后不好,近一半的人在三年内再次住院或死亡.
科学领域:
- 心脏病学 心脏病学
- 老年病的医生 老年病的医生
- 临床药理学 临床药理学
背景情况:
- 急性心力衰竭 (AHF) 具有显著的发病率和死亡率,特别是在老年人群中.
- 准则导向医学疗法 (GDMT) 改善了结果,但其在老年人中的有效性需要进一步研究.
- 了解现实世界的GDMT应用及其对老年AHF患者的影响对于改善护理至关重要.
研究的目的:
- 分析现实世界关于GDMT处方和AHF老年人的患者结果的数据.
- 评估GDMT坚持和预后之间的关联,包括死亡率和再住院率.
- 确定在二级护理环境中对老年患者的AHF管理的改进领域.
主要方法:
- 一项前性队列研究,涉及97名连续60岁或以上的AHF患者.
- 在3年的随访期间,收集的数据是出院和再住院时的GDMT,以及所有原因的死亡率和与HF相关的住院治疗.
- 统计分析包括GDMT使用和Kaplan-Meier生存分析的比较,该分析按左心室喷射率 (LVEF) 分层.
主要成果:
- 在出院时,86%的患者接受了β-阻塞剂,76.3%的患者接受了氨酸酶系统 (RAS) 抑制剂;然而,在重新住院时,GDMT的处方减少了.
- 在再住院后,SGLT-2抑制剂使用率从5.4%增加到47.2% (p=0.04).
- 总体而言,73.1%的人在出院时接受了两或三阶段的GDMT,在再住院时降至61% (p=0.01);近一半的人在3年内再次住院或死亡.
结论:
- 在这个瑞士的二级护理环境中,大多数老年AHF患者在出院或再住院时没有最佳的GDMT.
- 这一群人的预后仍然很差,在3年的随访期间,再住院和死亡率很高.
- 研究结果强调,需要加强老年AHF患者的GDMT策略,以改善结果并减少疾病负担.
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