Risk-treatment mismatch in the pharmacotherapy of heart failure
Risk-treatment mismatch in the pharmacotherapy of heart failure
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DOI：
10.1001/jama.294.10.1240
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发表时间：
2005-09-14
影响因子：
120.7
通讯作者：
Laupacis, A
中科院分区：
文献类型：
--
作者：
Lee, DS;Tu, JV;Laupacis, A
背景 心力衰竭患者有多种死亡风险。为了最大限度地发挥现有药物疗法的益处，高死亡风险的患者应接受高比例的药物治疗。 目的 研究心力衰竭患者的药物治疗模式和潜在的死亡风险。 设计、设置和患者 在加拿大安大略省住院的 9942 名心力衰竭患者的有效心脏治疗增强反馈 (EFFECT) 人群队列（1999-2001 年）中，我们评估了 1418 名记录左心室射血分数为 40% 或 40% 的患者。年龄在 79 岁以下且 1 年内预测死亡风险低、平均和高的人；所有患者均存活至出院。根据预测的死亡风险评估血管紧张素转换酶（ACE）抑制剂、ACE抑制剂或血管紧张素II受体阻滞剂（ARB）和β-肾上腺素受体拮抗剂的使用情况。主要指标出院时和出院后90天的心力衰竭药物使用率。结果出院时，低危组、中危组和高危组患者的处方率分别为81%、73%， ACE抑制剂分别为60%； ACE抑制剂或ARB分别为86%、80%、65%； β-肾上腺素受体拮抗剂分别为 40%、33%、24%（所有 P
Context Patients with heart failure have a wide spectrum of mortality risks. To maximize the benefit of available pharmacotherapies, patients with high mortality risk should receive high rates of drug therapy.Objective To examine patterns of drug therapy and underlying mortality risk in patients with heart failure.Design, Setting, and Patients In the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) population-based cohort (1999-2001) of 9942 patients with heart failure hospitalized in Ontario, Canada, we evaluated 1418 patients with documented left ventricular ejection fraction of 40% or less and aged 79 years or younger with low-, average-, and high-predicted risk of death within 1 year; all patients survived to hospital discharge. Administration of angiotensin-converting enzyme (ACE) inhibitors, ACE inhibitors or angiotensin II receptor blockers (ARBs), and beta-adrenoreceptor antagonists was evaluated according to predicted risk of death.Main Outcome Measure Heart failure drug administration rates at time of discharge and 90 days after hospital discharge.Results At hospital discharge, prescription rates for patients in the low-, average-, and high-risk groups were 81%, 73%, 60%, respectively, for ACE inhibitors; 86%, 80%, 65%, respectively, for ACE inhibitors or ARBs; and 40%, 33%, 24%, respectively, for beta-adrenoreceptor antagonists (all P