Challenges in the Implementation of Medical Therapy in Heart Failure
Challenges in the Implementation of Medical Therapy in Heart Failure
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心力衰竭药物治疗实施的挑战
DOI：
10.1016/j.jchf.2023.04.001
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Jordan-Rios A
中科院分区：
文献类型：
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作者：
Jordan-Rios A
指南指导的药物治疗 (GDMT) 可显着减少左心室射血分数降低的慢性心力衰竭 (CHF)（射血分数降低的心力衰竭 [HFrEF]）的心血管死亡和住院率2 因此，与标准治疗相比，可以将生存期延长 5 至 6 年。 3 尽管 GDMT 具有明显的益处，但实施不足是临床实践中的一个常见问题，并且很大一部分心力衰竭 (HF) 患者没有接受充分滴定的 GDMT。Moghaddam 等人的当前工作 4 为表 3 带来了不同且重要的因素：已知的 HF 药物治疗使用不足；正在研究的弱势群体（住院后）；以及正在考虑的心力衰竭的不同表型（即，新发心力衰竭与失代偿性心力衰竭）。本研究旨在确定患有 HFrEF 或射血分数保留的心力衰竭 (HFpEF) 患者在因 HF 住院后开始 GDMT 的资格。为此，我们对加拿大心力衰竭登记处的 809 名连续患者进行了分析。 Moghaddam 等人 4 定义
Guideline-directed medical therapy(GDMT) significantly decreases cardiovascular death and hospitalizations in chronic heart failure (CHF) with reduced left ventricular ejection fraction (heart failure with reduced ejection fraction [HFrEF]) 2 As such, it can result in an increase in survival of between 5 and 6 years compared to standard therapy. 3 Despite the clear benefits of GDMT, underimplementation is a common problem in clinical practice and a significant proportion of patients with heart failure (HF) do not receive adequately titrated GDMT.The present work by Moghaddam et al 4 brings to the table 3 different and important ingredients: the known underuse of medical therapy in HF; the vulnerable population being studied (after a hospitalization); and the different phenotypes of HF being considered (ie, de novo vs a decompensation of CHF). This study aimed to establish the eligibility of patients with HFrEF or heart failure with preserved ejection fraction (HFpEF) for the initiation GDMT following hospitalization for HF. To do so, 809 consecutive patients from the Canadian Heart Failure Registry were analyzed. Moghaddam et al 4 defined