在心力衰竭住院治疗的成年人中,多药和指导性医疗治疗的启动
Chukwuma Onyebeke1, David Zhang1, Mahad Musse2
1Department of Medicine, Weill Cornell Medicine, New York, New York, USA.
JACC. Advances
|August 30, 2024
概括
多药性,即使用多种药物,显著阻碍了心力衰竭患者的指导指导医学治疗 (GDMT). 服用5种或以上药物的患者不太可能接受指示治疗,这突出了最佳心力衰竭护理的关键障碍.
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.
- 临床医学 临床医学
背景情况:
- 针对心力衰竭 (HF) 的指南导向医疗疗 (GDMT) 仍然处方不足.
- 多药性是HF患者的常见问题,可能会影响治疗的坚持和疗效.
研究的目的:
- 调查多药性作为一个重要的障碍,启动和坚持GDMT在患有HF的患者.
- 评估患者服用药物的数量与他们接受适当HF治疗的可能性之间的关系.
主要方法:
- 从2003-2017年对住院HF患者 (减少喷射率和轻微减少喷射率) 的分析 (中风研究地理和种族差异的原因).
- 基于入院时的药物计数 (0-4,5-9,≥10) 的参与者的分层.
- 检查GDMT使用,禁忌和启动率,使用多变量Poisson回归来确定药物数量和GDMT启动之间的关联.
主要成果:
- 在入院时,很大一部分高血压患者没有接受指导方针导向的治疗,包括β抑制剂,ACE抑制剂/ARB/RNAI,MRA,抗血小板药,他类药和抗凝药.
- 多药性与至少一种指示药物 (RR:0.67为5-9药物,0.50为≥10药物) 和至少一半的指示药物 (RR:0.64为5-9药物,0.50为≥10药物) 的启动相反相关.
结论:
- 多药在心力衰竭患者实施指导方针导向的医疗治疗方面构成了重大障碍.
- 管理多药的策略对于改善GDMT的遵守和优化心力衰竭结果至关重要.
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