When the Whole Is the Sum of Its Parts: Validation of the Heart Failure Collaboratory Medication Composite Score in Denmark.
When the Whole Is the Sum of Its Parts: Validation of the Heart Failure Collaboratory Medication Composite Score in Denmark.
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当整体就是部分之和时：丹麦心力衰竭协作药物综合评分的验证。
DOI：
10.1161/circheartfailure.122.010309
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Allen,LarryA
中科院分区：
文献类型：
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作者：
Ahmad,FarazS;Ahmad,Tariq;Allen,LarryA
心力衰竭伴射血分数降低（HFrEF）的治疗受益于越来越多的循证疗法，这些疗法可改善心室重构、治疗症状、减少住院时间并延长生存期。这些治疗的效果通常是累加性的，因此当代的HFrEF管理涉及多种药物联合使用，随着时间的推移剂量最大化，并对耐受性和副作用进行连续评估，最终实现健康结果的显著改善。考虑到这种相对复杂性，这种情况经常发生在患者中，如多重疾病和多种药物，处方指南导向的药物治疗（GDMT）很少是最佳的。HFrEF登记和研究一致表明，在符合条件的患者中存在明显的使用不足和剂量不足。这种不充分的使用剥夺了患者重要的护理，正如最近的STRONG-HF试验（急性心力衰竭指南指导药物治疗的安全性、耐受性和有效性）显示，随机分配到积极强化GDMT干预的患者在6个月内导致HF住院和全因死亡的绝对减少8%。5
The treatment of heart failure with reduced ejection fraction (HFrEF) has benefitted from a growing number of evidence-based therapies that improve ventricular remodeling, treat symptoms, reduce hospitalization, and extend survival. 1 The effects of these treatments are generally additive, such that contemporary HFrEF management involves multiple medications used together, dose-maximized over time, with serial assessment of tolerance and side effects, ultimately to achieve significant improvements in health outcomes. 2 Given this relative complexity, which occurs in patients who frequently have issues like multimorbidity and polypharmacy, prescribing guideline-directed medical therapies (GDMT) for HFrEF is rarely optimal. HFrEF registries and studies have consistently shown significant underuse and underdosing in eligible patients. 3, 4 This underuse deprives patients of important care, as the recent STRONG-HF trial (Safety, Tolerability, and Efficacy of Up-Titration of Guideline-Directed Medical Therapies for Acute Heart Failure) showed that patients randomized to an intervention that aggressively intensified GDMT lead to an absolute reduction in HF hospitalization and all-cause death by 8% over 6 months. 5