循环利尿剂,心力衰竭诊断和初级保健中的结果
J J Cuthbert1, S Lomax2, I Soyiri3
1Department of Cardiology, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull HU6 7RX, United Kingdom; Department of Cardiology, Hull University Teaching Hospitals Trust, Castle Hill Hospital, Cottingham, Kingston-Upon-Hull HU16 5JQ, United Kingdom.
International journal of cardiology
|May 20, 2025
概括
循环利尿剂是常见的,但心力衰竭 (HF) 评估是罕见的. 当进行时,HF诊断发生在15%的患者中,对于高尿素 (NP) 的专家转诊可以降低死亡风险.
科学领域:
- 心脏病学 心脏病学
- 初级医疗保健医学 一级医疗保健医学
- 医疗信息学 医疗信息学
背景情况:
- 循环利尿剂在初级保健机构中经常被处方.
- 循环利尿剂处方后对心力衰竭 (HF) 的有效评估,诊断和管理需要进一步调查.
- 了解HF评估途径对于优化患者的治疗结果至关重要.
研究的目的:
- 为了调查心力衰竭 (HF) 评估和诊断率,在没有先前HF诊断的患者处方循环利尿剂.
- 探索HF评估,尿素 (NP) 测试和随后的临床结果,包括死亡率之间的关联.
主要方法:
- 利用临床实践研究数据链接黄金数据库与医院病例统计和英国国家统计局死亡登记处联系在一起.
- 确定了71,847名没有HF诊断的患者被处方循环利尿剂,分析了HF评估 (NP测试,心声学,心脏病转诊) 和五年内诊断率.
- 根据国家卫生和护理卓越研究所 (NICE) 和欧洲心脏病学会 (ESC) 的门检查了NP水平,并根据心脏病学推评估了死亡风险.
主要成果:
- 只有14%的没有HF诊断的处方循环利尿剂的患者接受了HF评估.
- 在五年内,15%的被评估患者被诊断为HF.
- 在高于NICE值的NP水平的患者中,向心脏病治疗的转诊与所有原因死亡风险 (47%与57%相比) 的显著降低有关.
结论:
- 在没有HF诊断的情况下开始使用循环利尿剂的患者中,很大一部分患者没有得到及时的HF评估.
- 值得注意的是,在被评估的患者中,有很大一部分被诊断为HF,这凸显了系统评估的重要性.
- 在循环利尿剂处方后,心脏病学转诊患者的 natriuretic 的升高与改善的生存结果有关.
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