Clinical Course of Patients With Worsening Heart Failure With Reduced Ejection Fraction
Clinical Course of Patients With Worsening Heart Failure With Reduced Ejection Fraction
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DOI：
10.1016/j.jacc.2018.11.049
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发表时间：
2019-03-05
影响因子：
24
通讯作者：
Givertz, Michael M.
中科院分区：
文献类型：
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作者：
Butler, Javed;Yang, Mei;Givertz, Michael M.
背景在现实世界中，心力衰竭恶化和射血分数降低（HFrEF）患者的流行病学没有得到很好的描述。和在真实的中发生心力衰竭（HF）恶化的HFrEF患者的结局-方法将来自国家心血管数据登记处PINNACLE的HFrEF事件患者的数据与药房、私人执业医师和医院索赔数据库相关联。发生率、临床特征、治疗（血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂、β-受体阻滞剂和盐皮质激素受体拮抗剂）和HF恶化患者的结局进行了评估，HF恶化定义为>= 90天的稳定HF，随后恶化需要静脉利尿剂。851例（17%）在首次HF诊断后平均1.5年出现HF恶化。发生HF恶化的患者更可能是非洲裔美国人、老年人，并且有更高的合并症负担（p < 0.001）。在HF恶化发作时，42.4%的患者接受单药治疗，43.4%接受双联治疗，14.1%接受三联治疗。血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂、β受体阻滞剂和盐皮质激素受体拮抗剂的目标剂量分别为48%、61%和98%。2年死亡率为22.5%，56%的患者在HF事件恶化后30天内再次住院。结论：在现实世界中，1/6的HFrEF患者在HF诊断后18个月内发生HF恶化。这些患者2年死亡率和复发性HF住院的风险很高。HF恶化发作前后标准治疗的使用率较低。由于医疗需求高度未得到满足，心力衰竭恶化的患者需要新型治疗策略以及对现有指南指导的治疗进行更大程度的优化。(c)2019年由美国心脏病学会基金会。
BACKGROUND Epidemiology of patients with worsening heart failure and reduced ejection fraction (HFrEF) in the real-world setting is not well described.OBJECTIVES The purpose of this study was to describe incidence, clinical characteristics, treatment, and outcomes of patients with HFrEF who develop worsening heart failure (HF) in the real-world setting.METHODS Data on patients with incident HFrEF from the National Cardiovascular Data Registry PINNACLE were linked to pharmacy, private practitioner, and hospital claims databases. Incidence, clinical characteristics, treatment (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker, and mineralocorticoid receptor antagonist) and outcomes of patients with worsening HF, defined as >= 90 days of stable HF with subsequent worsening requiring intravenous diuretic agents, were assessed.RESULTS Of 11,064 HFrEF patients, 1,851 (17%) developed worsening HF on average 1.5 years following initial HF diagnosis. Patients who developed worsening HF were more likely to be African American, be octogenarians, and have higher comorbidity burden (p < 0.001). At the onset of worsening HF, 42.4% of patients were on monotherapy, 43.4% were on dual therapy, and 14.1% were on triple therapy. A total of 48%, 61%, and 98% of patients were on > 50% target dose for angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker, and mineralocorticoid receptor antagonist, respectively. The 2-year mortality rate was 22.5%, and 56% of patients were rehospitalized within 30 days of the worsening HF event.CONCLUSIONS In the real-world setting, 1 in 6 patients with HFrEF develop worsening HF within 18 months of HF diagnosis. These patients have a high risk for 2-year mortality and recurrent HF hospitalizations. The use of standard-of-care therapies both before and after the onset of worsening HF is low. With high unmet medical need, patients with worsening HF require novel treatment strategies as well as greater optimization of existing guideline-Ddirected therapy. (c) 2019 by the American College of Cardiology Foundation.