2017 Comprehensive Update of the Canadian Cardiovascular Society Guidelines for the Management of Heart Failure
2017 Comprehensive Update of the Canadian Cardiovascular Society Guidelines for the Management of Heart Failure
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DOI：
10.1016/j.cjca.2017.08.022
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发表时间：
2017-11-01
影响因子：
6.2
通讯作者：
Sussex, Bruce
中科院分区：
文献类型：
--
作者：
Ezekowitz, Justin A.;O'Meara, Eileen;Sussex, Bruce
自2006年加拿大心血管学会心力衰竭（HF）指南发布以来，HF患者的护理发生了很大变化。在过去的十年中，HF指南委员会定期发布更新。然而，由于发生了重大变化，准则委员会认为，目前需要对HF管理建议进行全面的重新评估，以便制定一套完整的更新指南。加拿大心血管学会HF专家组的主要和次要成员以及外部专家已审查了临床相关文献，为执业临床医生提供指导。2017年HF指南提供了关于诊断和管理（自我护理、药物、非药物、器械和转诊）的最新指南，这些指南应有助于HF患者的日常护理决策。具体内容包括风险评分、射血分数保留与降低的心力衰竭管理差异、运动和康复、植入式器械、血运重建、右心室功能障碍、贫血和缺铁、心肾综合征、睡眠呼吸暂停、心肌病、妊娠期心力衰竭、心脏肿瘤和心肌炎。我们关注预防心力衰竭的策略和治疗、心力衰竭护理的组织、合并症管理以及转诊和随访护理时机的实际问题。晚期HF的识别和治疗是本次更新的另一个重要方面，包括如何选择先进的治疗方法以及生命结束时的注意事项。最后，我们承认，在证据方面仍然存在空白，需要通过未来的研究来填补。
Since the inception of the Canadian Cardiovascular Society heart failure (HF) guidelines in 2006, much has changed in the care for patients with HF. Over the past decade, the HF Guidelines Committee has published regular updates. However, because of the major changes that have occurred, the Guidelines Committee believes that a comprehensive reassessment of the HF management recommendations is presently needed, with a view to producing a full and complete set of updated guidelines. The primary and secondary Canadian Cardiovascular Society HF panel members as well as external experts have reviewed clinically relevant literature to provide guidance for the practicing clinician. The 2017 HF guidelines provide updated guidance on the diagnosis and management (self-care, pharmacologic, non-pharmacologic, device, and referral) that should aid in day-to-day decisions for caring for patients with HF. Among specific issues covered are risk scores, the differences in management for HF with preserved vs reduced ejection fraction, exercise and rehabilitation, implantable devices, revascularization, right ventricular dysfunction, anemia, and iron deficiency, cardiorenal syndrome, sleep apnea, cardiomyopathies, HF in pregnancy, cardio-oncology, and myocarditis. We devoted attention to strategies and treatments to prevent HF, to the organization of HF care, comorbidity management, as well as practical issues around the timing of referral and follow-up care. Recognition and treatment of advanced HF is another important aspect of this update, including how to select advanced therapies as well as end of life considerations. Finally, we acknowledge the remaining gaps in evidence that need to be filled by future research.