Treatment and Risk in Heart Failure Gaps in Evidence or Quality?
Treatment and Risk in Heart Failure Gaps in Evidence or Quality?
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DOI：
10.1161/circoutcomes.109.879478
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发表时间：
2010-05-01
影响因子：
6.9
通讯作者：
Masoudi, Frederick A.
中科院分区：
文献类型：
--
作者：
Peterson, Pamela N.;Rumsfeld, John S.;Masoudi, Frederick A.
背景--尽管干预的绝对益处与患者的潜在风险成正比，但心力衰竭研究发现治疗与风险之间存在矛盾的反比关系。在何种程度上，这反映了较高的风险或较大的差距，在护理quality.Methods和结果，我们研究了18307例左心室收缩功能障碍生存住院治疗的患者在2005年1月至2007年6月从194家医院参加了指南（GWTG）-心力衰竭的禁忌症的发生率较高。使用经验证的风险评分，根据患者的估计院内死亡风险对患者进行分类。在不同风险水平下，确定了记录有血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂和β受体阻滞剂禁忌症的患者比例，以及出院时无禁忌症的患者中使用这些药物的比例。对于每种治疗，有禁忌症的患者比例随着患者风险的增加而显著增加（P
Background-Although the absolute benefits of an intervention are proportional to patients' underlying risk, studies in heart failure have noted a paradoxical inverse relationship between treatment and risk. The extent to which this reflects higher rates of contraindications in patients with higher risk or larger gaps in care quality has not been explored.Methods and Results-We studied 18 307 patients with left ventricular systolic dysfunction surviving hospitalization between January 2005 and June 2007 from 194 hospitals participating in Get With The Guidelines (GWTG)-Heart Failure. Patients were categorized according to their estimated risk for in-hospital mortality using a validated risk score. The proportions of patients with documented contraindications to angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and beta-blockers as well as the use of these medications among patients without contraindications at hospital discharge was determined across levels of risk. For each therapy, the proportion of patients with contraindications was significantly higher with increasing patient risk (P