Guideline-Directed Medical Therapy in Newly Diagnosed Heart Failure With Reduced Ejection Fraction in the Community.
Guideline-Directed Medical Therapy in Newly Diagnosed Heart Failure With Reduced Ejection Fraction in the Community.
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DOI：
10.1016/j.cardfail.2022.07.047
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发表时间：
2022-10
影响因子：
6
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指南指导的药物治疗（GDMT）显著改善射血分数降低（HFrEF）心力衰竭的结局。我们的目标是检查社区新诊断的HFrEF患者使用GDMT的情况。我们对2007-2017年明尼苏达州奥姆斯特德县所有新诊断HFrEF（EF≤40%）的居民进行了一项基于人群的回顾性队列研究。我们排除了有用药禁忌症的患者。我们检查了β受体阻滞剂、HF β受体阻滞剂（琥珀酸美托洛尔、卡维地洛、比索洛尔）、ACEi/ARB/ARNI和MRA在HFrEF诊断后第一年的使用情况。我们使用考克斯模型来评估在HF诊所就诊与开始GDMT的相关性。2007-2017年，1160例患者被诊断为HFrEF（平均年龄69.7岁，65.6%为男性）。大多数合格患者在第一年接受β受体阻滞剂（92.6%）和ACEi/ARB/ARNI（87.0%）。然而，只有63.8%的患者接受了HF β受体阻滞剂治疗，很少接受MRA（17.6%）。在解释HF诊所在开始这些药物治疗中的作用的模型中，在HF诊所就诊与所有药物类别中开始新的GDMT独立相关，HR（95% CI）为1.54（1.15-2.06），HF β受体阻滞剂2.49（1.95-3.20），ACEi/ARB/ARNI 1.97（1.46-2.65），MRA 2.14（1.49-3.08）。在这项基于人群的研究中，大多数新诊断的HFrEF患者接受β受体阻滞剂和ACEi/ARB/ARNI治疗。在HF诊所就诊的患者中，GDMT的使用率较高，这表明新诊断的HFrEF患者转诊至HF诊所的潜在获益。虽然大多数射血分数低的心力衰竭患者在诊断后的第一年接受一些药物治疗心力衰竭，但仍有改善的机会。随着治疗心力衰竭的新药的批准，这将变得更加复杂。新诊断为心力衰竭和射血分数低的患者如果在心力衰竭专科诊所就诊，则心力衰竭药物的使用率较高。
Guideline-directed medical therapy (GDMT) dramatically improves outcomes in heart failure with reduced ejection fraction (HFrEF). Our goal was to examine GDMT use in community patients with newly diagnosed HFrEF. We performed a population-based, retrospective cohort study of all Olmsted County, Minnesota residents with newly diagnosed HFrEF (EF≤40%) 2007–2017. We excluded patients with contraindications to medication initiation. We examined use of beta blockers, HF beta blockers (metoprolol succinate, carvedilol, bisoprolol), ACEi/ARB/ARNI, and MRA in the first year after HFrEF diagnosis. We used Cox models to evaluate the association of being seen in a HF clinic with initiation of GDMT. From 2007–2017, 1160 patients were diagnosed with HFrEF (mean age 69.7 years, 65.6% men). Most eligible patients received beta blockers (92.6%) and ACEi/ARB/ARNI (87.0%) in the first year. However, only 63.8% of patients were treated with a HF beta blocker, and few received MRAs (17.6%). In models accounting for the role of HF clinic in initiation of these medications, being seen in a HF clinic was independently associated with initiation of new GDMT across all medication classes, with HR (95% CI) of 1.54 (1.15–2.06)for any beta blocker, 2.49 (1.95–3.20) for HF beta blockers, 1.97 (1.46–2.65) for ACEi/ARB/ARNI, and 2.14 (1.49–3.08) for MRAs. In this population-based study, most patients with newly diagnosed HFrEF received beta blockers and ACEi/ARB/ARNIs. GDMT use was higher in patients seen in a HF clinic, suggesting potential benefit of referral to a HF clinic for patients with newly diagnosed HFrEF. While most patients with heart failure with low ejection fraction receive some medications to treat their heart failure in the first year after diagnosis, there is still opportunity for improvement. This will become even more complex with approval of new medications to treat heart failure. Patients who are newly diagnosed with heart failure and a low ejection fraction have higher use of heart failure medications if they are seen in a heart failure specialty clinic.
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