心力衰竭管理中的处方模式及其与再入院的关联:回顾性分析
Simran Agrawal1, Zayd Alhaddad1, Sarah Nabia2
1Department of Medicine, MedStar Health, Baltimore, Maryland.
Journal of cardiac failure
|September 27, 2024
概括
针对心力衰竭与减少喷射率 (HFrEF) 的指南导向医学治疗 (GDMT) 在医院出院时处方不足. 提高GDMT处方率对于更好的患者结果和减少再入院至关重要.
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:
- 针对心力衰竭与减少喷射分数 (HFrEF) 的指南导向医学治疗 (GDMT) 现在包括四个支柱:胺- ангиотензин-阿尔多素系统抑制剂,β-阻断剂,矿物质皮质醇受体对抗剂和-葡萄糖共传输体-2 抑制剂.
- 尽管有证据表明,在目标剂量内入院患者启动GDMT后,结果有所改善,但处方实践存在显著的滞后.
研究的目的:
- 评估HFrEF患者在医院出院时的GDMT处方率.
- 评估患者特征与GDMT处方之间的关联.
- 检查GDMT处方和1个月所有原因再入院率之间的关系.
主要方法:
- 利用修改的心力衰竭协作室 (HFC) 评分来根据GDMT处方对患者进行分类.
- 分析了个别GDMT类和复合分数的处方率.
- 研究了影响GDMT处方的社会经济和生物医学因素.
主要成果:
- 出院时的处方率是:β-阻断剂 (77.9%),氨酸- ангиотензин- 阿尔多素系统抑制剂 (70.3%),矿物质皮质体受体对抗剂 (41%),萨库比特里尔/瓦尔萨坦 (27.7%) 和-葡萄糖携带体-2 抑制剂 (17%).
- 只有1%的患者在目标剂量时接受了所有四种GDMT类 (HFC分数为9).
- 较高的HFC分数 (≥3) 与较低的1个月全因再入院相关,并与黑人种族,入学教学服务和HFrEF作为主要诊断有关.
结论:
- 对于HFrEF的GDMT在住院处方中仍然存在显著的差距.
- 实施研究是必要的,以加强在住院期间的GDMT处方.
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