在心力衰竭和减少排泄分数的患者中,重新审视ICD疗法用于初级预防
Amin Yehya1, Jose Lopez2, Andrew J Sauer3
1Advanced Heart Failure Center, Sentara Heart Hospital, Norfolk, Virginia, USA.
JACC. Heart failure
|December 6, 2024
概括
植入式心脏转换器-除器 (ICD) 建议用于心力衰竭患者,以预防心脏突然死亡 (SCD). 本综述根据现代疗法对ICD进行了审查,并为初级预防决策提出了指导意见.
科学领域:
- 心脏病学 心脏病学
- 医疗器械 医疗器械
- 临床试验 临床试验
背景情况:
- 植入式心脏转换器-除器 (ICD) 建议用于预防心脏突发死亡 (SCD) 的初级预防,患者心力衰竭与减少喷射率 (HFrEF).
- 支持ICD使用的里程碑式试验早于当前的指导方针导向医学疗法 (GDMT),促使人们重新评估其作用.
- 当代临床实践需要在先进的心力衰竭管理时代对ICD疗效和患者选择进行审查.
研究的目的:
- 提供关于HFrEF中初级预防的当前ICD建议的全面概述.
- 分析指南导向医学疗法 (GDMT) 对SCD风险和ICD益处的影响.
- 提供关于初级ICD植入的共享决策的务实指导.
主要方法:
- 对HFrEF患者中SCD风险的仪器临床试验和现实世界的数据的审查.
- 在不同患者群体中对ICD使用的差异分析.
- 评估当代GDMT对HFrEF患者结果的影响.
- 检查正在进行和未来的试验,以改善SCD风险分层.
主要成果:
- 由于GDMTs的演变,ICDs在初级预防中的作用受到争议.
- 现实世界SCD风险和ICD益处可能与里程碑性试验观察结果不同.
- 在ICD使用中的差异突出了在获得护理方面的潜在不平等.
- 优化GDMT可能会改变HFrEF中的ICD的风险-收益概况.
结论:
- 目前的ICD指南需要在现代GDMT的背景下重新评估.
- 需要改进的风险分层工具来识别HFrEF患者,这些患者将从ICD中获益最多.
- 基于最新证据的共享决策对于适当的初级ICD植入至关重要.
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