心力衰竭与减少喷射分数:对临床实践指南和建议的系统审查
Shayan Datta1, Sunrit Majumder2, Gaurav S Gulsin3
1University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK.
概括
减少喷射率心力衰竭 (HFrEF) 的国际指导方针在基础治疗方面达成共识,但在特定治疗和并发症管理方面存在分歧. 需要更大的协调,以优化全球HFrEF护理.
科学领域:
- 心脏病学 心脏病学
- 临床实践指南 临床实践指南
- 系统审查是系统的审查.
背景情况:
- 减少喷射分数 (HFrEF) 的心力衰竭占所有心力衰竭病例的一半以上.
- 根据国际临床实践指南,HFrEF的管理是指导性的.
研究的目的:
- 系统地审查和评估当前关于成人HFrEF诊断和管理的国际指南.
- 在高质量的指南中确定共识和分歧的领域.
主要方法:
- 对过去十年的出版物进行了MEDLINE和EMBASE数据库的系统审查.
- 搜索了相关医学协会的网站,并使用AGREE II标准评估了指南.
- 确定了12条指导方针,其中7条符合最终分析的严格开发标准.
主要成果:
- 在HFrEF预防,定义和初始诊断策略方面存在广泛的共识,包括先进的成像和侵入性血管学.
- 在核心药理疗法方面达成一致:氨酸- ангиотензин-阿尔多素系统 (RAAS) 抑制剂,β-阻断剂,矿物质皮质类受体对抗剂和SGLT2抑制剂.
- 在尿素值,RAAS抑制剂测序,设备治疗指示 (ICD,CRT),再血管化和早期HFrEF (A和B) 的管理方面观察到关键差异.
结论:
- 虽然基本的HFrEF治疗方法得到了广泛的认可,但对于先进疗法,分期和并发症管理的建议存在显著的变化.
- 这些发现强调了需要加强HFrEF指导方针的协调,以在全球范围内规范和改进患者护理.
- 解决常见的并发症,如缺铁,心房动,肥胖和虚弱,需要在HFrEF指南中更加关注.
相关概念视频
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