Medical Therapy for Heart Failure With Reduced Ejection Fraction
Medical Therapy for Heart Failure With Reduced Ejection Fraction
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DOI：
10.1016/j.jacc.2018.04.070
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发表时间：
2018-07-24
影响因子：
24
通讯作者：
Fonarow, Gregg C.
中科院分区：
文献类型：
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作者：
Greene, Stephen J.;Butler, Javed;Fonarow, Gregg C.
背景指南强烈建议射血分数降低的心力衰竭（HFrEF）患者接受经证实可改善临床结局的多种药物治疗（如耐受）。在何种程度上的差距，在药物使用和剂量持续在当代门诊practice. Acceptives这项研究旨在表征模式和因素与使用和剂量的HFrEF药物在当前practice. METHODS CHAMP-HF（改变管理的心力衰竭患者）注册表包括门诊患者在美国慢性HFrEF接受至少1种口服药物治疗HF。患者的特征是基线使用和剂量的血管紧张素转换酶抑制剂（ACEI）/血管紧张素II受体阻滞剂（ARB），血管紧张素受体脑啡肽酶抑制剂（ARNI），β受体阻滞剂，盐皮质激素受体拮抗剂（MRA）。患者水平的因素与药物使用examined. ResultsOverall，3,518例患者从150初级保健和心脏病学的做法。平均年龄为66 +/- 13岁，29%为女性，平均EF为29 +/-8%。在符合条件的患者中，分别有27%、33%和67%的患者未接受ACEI/ARB/ARNI、β受体阻滞剂和MRA治疗。当处方药物时，很少有患者接受ACEI/ARB（17%），ARNI（14%）和β受体阻滞剂（28%）的目标剂量，而大多数患者接受MRA治疗的目标剂量（77%）。在符合所有类别药物治疗条件的患者中，1%的患者同时接受ACE/ARB/ARNI、β受体阻滞剂和MRA的目标剂量。在调整后的模型中，年龄较大、血压较低、功能分级较重、肾功能不全和近期HF住院通常有利于降低药物利用或剂量。社会和经济特征与药物使用或dose.CONCLUSIONS在当代门诊HFrEF注册，指南指导的药物治疗的使用和剂量的显着差距仍然存在。多种临床因素与药物使用和处方剂量相关。仍然迫切需要改善HFrEF药物指南指导使用的策略，这些发现可能会为优化门诊药物治疗提供有针对性的方法。(C)2018年由美国心脏病学会基金会。
BACKGROUND Guidelines strongly recommend patients with heart failure with reduced ejection fraction (HFrEF) be treated with multiple medications proven to improve clinical outcomes, as tolerated. The degree to which gaps in medication use and dosing persist in contemporary outpatient practice is unclear.OBJECTIVES This study sought to characterize patterns and factors associated with use and dose of HFrEF medications in current practice.METHODS The CHAMP-HF (Change the Management of Patients with Heart Failure) registry included outpatients in the United States with chronic HFrEF receiving at least 1 oral medication for management of HF. Patients were characterized by baseline use and dose of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB), angiotensin receptor neprilysin inhibitor (ARNI), beta-blocker, and mineralocorticoid receptor antagonist (MRA). Patientlevel factors associated with medication use were examined.RESULTS Overall, 3,518 patients from 150 primary care and cardiology practices were included. Mean age was 66 +/- 13 years, 29% were female, and mean EF was 29 +/- 8%. Among eligible patients, 27%, 33%, and 67% were not prescribed ACEI/ARB/ARNI, beta-blocker, and MRA therapy, respectively. When medications were prescribed, few patients were receiving target doses of ACEI/ARB (17%), ARNI (14%), and beta-blocker (28%), whereas most patients were receiving target doses of MRA therapy (77%). Among patients eligible for all classes of medication, 1% were simultaneously receiving target doses of ACE/ARB/ARNI, beta-blocker, and MRA. In adjusted models, older age, lower blood pressure, more severe functional class, renal insufficiency, and recent HF hospitalization generally favored lower medication utilization or dose. Social and economic characteristics were not independently associated with medication use or dose.CONCLUSIONS In this contemporary outpatient HFrEF registry, significant gaps in use and dose of guideline-directed medical therapy remain. Multiple clinical factors were associated with medication use and dose prescribed. Strategies to improve guideline-directed use of HFrEF medications remain urgently needed, and these findings may inform targeted approaches to optimize outpatient medical therapy. (C) 2018 by the American College of Cardiology Foundation.