Potential impact of optimal implementation of evidence-based heart failure therapies on mortality
Potential impact of optimal implementation of evidence-based heart failure therapies on mortality
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DOI：
10.1016/j.ahj.2011.01.027
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发表时间：
2011-06-01
影响因子：
4.8
通讯作者：
Heidenreich, Paul A.
中科院分区：
文献类型：
--
作者：
Fonarow, Gregg C.;Yancy, Clyde W.;Heidenreich, Paul A.
背景：虽然多种治疗方法已被证明能降低心力衰竭患者的死亡率和降低左心室射血分数，但其在临床实践中的应用并不理想。到目前为止，对通过优化实施消除这些现有治疗差距可能获得的潜在好处的经验估计还没有被量化。方法从已发表的来源获得每种循证HF治疗的合格标准、使用/不使用特定治疗的估计频率、病死率和治疗所导致的风险降低。结果在美国左心室射血分数降低的心力衰竭患者(n=2,644,800)中，符合条件但目前未接受治疗的患者数量范围为139,749人(肼/硝酸异山梨酯)至852,512人(植入型心脏复律除颤器)。通过最佳应用血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂，每年可预防的死亡比较数为6,516例；β-受体阻滞剂为12,922例；醛固酮拮抗剂为21,407例；肼/硝酸异山梨酯为6,655例；心脏再同步治疗为8,317例；植入式心律转复除颤器为12,179例。如果这些治疗益处是累加的，那么所有6种疗法的最佳实施可能每年防止67996人死亡。结论通过优化循证疗法的实施，美国可能会预防相当数量的心衰死亡。这些数据可能会强调绩效改进努力的重要性，以将循证治疗转化为常规临床实践，以降低当代心力衰竭的死亡率。(Am Heart J 2011；161：1024-1030.e3.)
Background Although multiple therapies have been shown to lower mortality in patients with heart failure (HF) and reduced left ventricular ejection fraction, their application in clinical practice has been less than ideal. To date, empiric estimation of the potential benefits that could be gained from eliminating these existing treatment gaps with optimal implementation has not been quantified.Methods Eligibility criteria for each evidence-based HF therapy, the estimated frequency of use/nonuse of specific treatments, the case fatality rates, and the risk reductions due to treatment were obtained from published sources. The numbers of deaths prevented or postponed because of each guideline-recommended therapy and overall were determined.Results Among patients with HF with reduced left ventricular ejection fraction in the United States (n = 2,644,800), the number eligible but not currently treated ranged from 139,749 for hydralazine/isorbide dinitrate to 852,512 for implantable cardioverter defibrillators. The comparative number of deaths that could potentially be prevented per year with optimal implementation of angiotensin-converting enzyme inhibitor/angiotensin receptor antagonist is 6,516; beta-blockers, 12,922; aldosterone antagonists, 21,407; hydralazine/isorbide dinitrate, 6,655; cardiac resynchronization therapy, 8,317; and implantable cardioverter defibrillators, 12,179. If these treatment benefits were additive, optimal implementation of all 6 therapies could potentially prevent 67,996 deaths a year.Conclusions A substantial number of HF deaths in this country could potentially be prevented by optimal implementation of evidence-based therapies. These data may underscore the importance of performance improvement efforts to translate evidence-based therapy to routine clinical practice so as to reduce contemporary HF mortality. (Am Heart J 2011;161:1024-1030.e3.)