Novel Strategies to Improve Prescription of Guideline-Directed Medical Therapy in Heart Failure.
Novel Strategies to Improve Prescription of Guideline-Directed Medical Therapy in Heart Failure.
复制标题
DOI：
10.1007/s11936-023-00979-4
复制
发表时间：
2023
影响因子：
--
通讯作者：
Martyn, Trejeeve
中科院分区：
文献类型：
--
作者：
Brooksbank, Jeremy A;Faulkenberg, Kathleen D;Tang, W H Wilson;Martyn, Trejeeve
检查正在研究的新策略的新兴数据，以改善心力衰竭（HF）患者指南导向药物治疗（GDMT）的使用和剂量滴定。有越来越多的证据表明，采用新的多管齐下的战略，以解决HF的实施差距。尽管有高水平的随机化证据和明确的国家学会建议，但在心力衰竭（HF）患者中指南指导的药物治疗（GDMT）的使用和剂量滴定方面仍存在很大差距。加速GDMT的安全实施已被证明可以降低与HF相关的发病率和死亡率，但对于患者，临床医生和卫生系统来说仍然是一个持续的挑战。在这篇综述中，我们研究了新的策略，以改善GDMT的使用，包括使用多学科团队为基础的方法，非传统的患者接触，患者信息/参与，远程患者监测和电子健康记录（EHR）为基础的临床警报的新兴数据。虽然社会指南和实施研究的重点是射血分数降低的心力衰竭（HFrEF），但扩大钠葡萄糖协同转运蛋白2（SGLT 2 i）的适应症和使用证据将需要在整个LVEF范围内开展实施工作。
To examine the emerging data for novel strategies being studied to improve use and dose titration of guideline-directed medical therapy (GDMT) for patients with heart failure (HF). There is mounting evidence to employ novel multi-pronged strategies to address HF implementation gaps. Despite high-level randomized evidence and clear national society recommendations, a large gap persists in use and dose titration of guideline-directed medical therapy (GDMT) in patients with heart failure (HF). Accelerating the safe implementation of GDMT has proven to reduce the morbidity and mortality associated with HF but remains an ongoing challenge for patients, clinicians, and health systems. In this review, we examine the emerging data for novel strategies to improve the use of GDMT including the use of multidisciplinary team-based approaches, nontraditional patient encounters, patient messaging/engagement, remote patient monitoring, and electronic health record (EHR)-based clinical alerts. While societal guidelines and implementation studies have focused on heart failure with reduced ejection fraction (HFrEF), expanding indications and evidence for the use of sodium glucose cotransporter2 (SGLT2i) will necessitate implementation efforts across the LVEF spectrum.