Contemporary strategies in the diagnosis and management of heart failure.
Contemporary strategies in the diagnosis and management of heart failure.
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心力衰竭诊断和管理的当代策略。
DOI：
10.1016/j.mayocp.2014.01.004
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发表时间：
2014-05
影响因子：
8.9
通讯作者：
Kushwaha SS
中科院分区：
文献类型：
--
作者：
Dunlay SM;Pereira NL;Kushwaha SS
心力衰竭(HF)是一个重要的公共卫生问题，需要采取策略来改善预后，降低医疗资源的利用率和成本。随着人口老龄化，心力衰竭的患病率有所上升，而且心力衰竭仍与高死亡率和频繁的住院需求有关。治疗心力衰竭患者的总费用为307亿美元，预计到2030年将增加一倍以上，达到698亿美元。鉴于这一现实，最近对高危患者(A期HF)和心脏结构和功能异常但没有临床HF症状的患者(B期)识别和预防HF的方法进行了研究。对于已经出现心力衰竭症状(C期)的患者，已经进行了重要的研究，以寻找最有效的方法来缓解入院的急性失代偿性心力衰竭患者的压力，并防止未来再次住院。我们继续寻找成功的策略来治疗心力衰竭和射血分数保留的患者，这种患者的患病率已经上升。由于机械循环支持的引入和改进，我们在护理终末期心衰(D期)患者的能力方面正在迅速发展。作为目的地治疗的左心室辅助装置为因高龄或过度合并疾病而不符合心脏移植资格的患者提供了一个重要的治疗选择。这篇综述将对过去几年出现的心力衰竭分期(A-D)的诊断和治疗的当代策略提供一个彻底的更新。
Heart failure (HF) is an important public health problem in need of strategies to improve outcomes and decrease healthcare resource utilization and costs. The prevalence has risen as the population ages and HF continues to be associated with a high mortality and frequent need for hospitalization. The total cost of care for patients with HF is $30.7 billion, and estimated to more than double to $69.8 billion by 2030. Given this reality, there has been recent investigation into ways of identifying and preventing HF in patients at risk (stage A HF) and those with cardiac structural and functional abnormalities but no clinical HF symptoms (Stage B). For patients who have developed symptoms of HF (Stage C), there has been important research into the most effective ways to decongest patients admitted with acute decompensated HF and prevent future hospital readmissions. We continue to search for successful strategies to treat patients with HF and preserved ejection fraction, which has risen in prevalence. We are in the midst of a rapid evolution in our ability to care for patients with end stage HF (Stage D) due to the introduction and improvement in mechanical circulatory support. Left ventricular assist devices used as destination therapy offer an important therapeutic option to patients who don’t qualify for heart transplantation due to advanced age or excess comorbidity. This review will provide a thorough update on contemporary strategies in the diagnosis and management of HF by stage (A to D) that have emerged in the last several years.