Patient profiling in heart failure for tailoring medical therapy. A consensus document of the Heart Failure Association of the European Society of Cardiology
Patient profiling in heart failure for tailoring medical therapy. A consensus document of the Heart Failure Association of the European Society of Cardiology
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DOI：
10.1002/ejhf.2206
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发表时间：
2021-05-20
影响因子：
18.2
通讯作者：
Coats, Andrew J. S.
中科院分区：
文献类型：
--
作者：
Rosano, Giuseppe M. C.;Moura, Brenda;Coats, Andrew J. S.
尽管有指南建议和现有证据，但心力衰竭（HF）治疗的实施情况很差。大多数患者没有得到已被证明对发病率和死亡率有积极影响的目标剂量的处方药物。除其他外，与低血压、心率、肾功能受损或高钾血症相关的耐受性问题是主要原因。慢性肾脏疾病在HF患者中起着重要作用，因为它影响高达50%的HF患者。此外，估计的肾小球滤过率在HF过程中可能发生动态变化，导致临床实践中不适当的剂量减少或甚至停止充血或神经激素调节治疗。由于HF患者很少接受过药物治疗，因此挑战在于根据患者特征充分优先考虑或选择最合适的剂量上调方案。在本共识文件中，我们确定了9个可能与射血分数降低的HF患者的治疗实施相关的患者特征。这些曲线考虑了心率（70 bpm）、房颤的存在、症状性低血压、估计的肾小球滤过率（30 mL/min/1.73 m2）或高钾血症。出院前的病人，经常仍然充血，也解决了。个性化的方法，调整指南导向的药物治疗，以患者的档案，可以允许实现更好的和更全面的治疗，为每一个病人比更传统的，强制滴定的每一类药物开始治疗前与下一个。
Despite guideline recommendations and available evidence, implementation of treatment in heart failure (HF) is poor. The majority of patients are not prescribed drugs at target doses that have been proven to positively impact morbidity and mortality. Among others, tolerability issues related to low blood pressure, heart rate, impaired renal function or hyperkalaemia are responsible. Chronic kidney disease plays an important role as it affects up to 50% of patients with HF. Also, dynamic changes in estimated glomerular filtration rate may occur during the course of HF, resulting in inappropriate dose reduction or even discontinuation of decongestive or neurohormonal modulating therapy in clinical practice. As patients with HF are rarely naive to pharmacologic therapies, the challenge is to adequately prioritize or select the most appropriate up-titration schedule according to patient profile. In this consensus document, we identified nine patient profiles that may be relevant for treatment implementation in HF patients with a reduced ejection fraction. These profiles take into account heart rate (70 bpm), the presence of atrial fibrillation, symptomatic low blood pressure, estimated glomerular filtration rate (30 mL/min/1.73 m(2)) or hyperkalaemia. The pre-discharge patient, frequently still congestive, is also addressed. A personalized approach, adjusting guideline-directed medical therapy to patient profile, may allow to achieve a better and more comprehensive therapy for each individual patient than the more traditional, forced titration of each drug class before initiating treatment with the next.