美国心力衰竭的当代指南导向医学疗法:EMPACE研究
Stephen J Greene1, Atif Adam2, Niklas Schmedt3
1Duke University Medical Center Duke Clinical Research Institute Durham NC USA.
Journal of the American Heart Association
|March 10, 2026
概括
在美国住院治疗心力衰竭 (HF) 患者中使用指南导向医学治疗 (GDMT) 显示了显著的差距. 住院后,GDMT的启动被推迟,停止率很高,这表明现实世界治疗模式不足最佳.
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:
- 临床指导方针和试验建议早期指导方针导向医学治疗 (GDMT) 治疗心力衰竭 (HF).
- 该EMPACE研究调查了美国住院患HF (HHF) 的患者在现实世界GDMT的使用情况.
研究的目的:
- 为了检查心力衰竭住院患者在美国临床实践中的GDMT模式.
- 评估住院前后GDMT的开始,停止和时间.
主要方法:
- 使用非身份化美国患者数据的观察性队列研究 (2020年6月-2023年9月).
- 在HHF之前和之后的12个月内评估GDMT的使用.
- 在开始后的12个月内评估药物停用率.
主要成果:
- 只有1%的HF降低射出分数 (HFrEF) 患者在HHF前接受了四倍治疗;这增加到HHF后的2%.
- 在HHF后,β阻塞剂使用率为84%,ACEi/ARB使用率为72%,MRA使用率为38%,ARNI使用率为26%,SGLT2i使用率为13%.
- 对于ARNI (62%),MRAs (57%),SGLT2i (55%) 和β抑制剂 (51%) 观察到高的12个月停药率.
- 在轻度降低EF (HFmrEF) 和保存EF (HFpEF) 的HF中使用-葡萄糖共传递者-2抑制剂 (SGLT2i) 的比例分别从HHF后的7%增加到12%和9%.
结论:
- 在美国,对于HFrEF患者的入院前四重疗法存在显著的差距.
- 退院后GDMT使用的情况略有改善,但其特点是延迟开始和高停药率.
- 在HFmrEF和HFpEF群体中,在SGLT2i使用方面也发现了类似的亚最佳模式.
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