Doba N, Tomiyama H, Nakayama T
The Third Department of Internal Medicine, Teikyo University School of Medicine, Ichihara Hospital, Japan.
Drugs Aging. 1999 Mar;14(3):153-63. doi: 10.2165/00002512-199914030-00001.
This article is a review of chronic compensated congestive heart failure (CHF), with special reference to its clinical features and pathophysiology and recent advances in pharmacotherapy, including beta-blockers, loop diuretics, ACE inhibitors and angiotensin II receptor antagonists. Clinical problems related to elderly patients and multifaceted aspects of multidisciplinary approaches of medical care to these particular patients are also discussed with special emphasis on the aspect of improved quality of life associated with reduced mortality. Concepts of CHF have greatly changed over the past decades with regard to its pathophysiology, natural progression, mechanisms, causes of death, arrhythmias and treatment goals. Although the current most frequent aetiologies of CHF include coronary heart disease and dilated cardiomyopathy, hypertension has been revisited in a different way, and has been considered of pivotal importance in most recent trends and possibly in future perspectives. Nowadays, however, with the results of improved survival, alleviation of symptoms, improvement in functional capacity and prevention of associated complications including even left ventricular remodelling through various appropriate pharmacotherapies, patients with CHF are used to being physically and psychosocially more active than ever before. Thus, improvement of patients' quality of life and reduction of mortality have become of prime importance in achieving treatment goals. Another emerging aspect of CHF is aging itself, and special features in the medical care of elderly patients with CHF always have to be taken into consideration in reduction of hospital readmission along with improvement of morbidity and mortality. Despite advances in the treatment of CHF, it remains a common disease with a poor prognosis. Therefore, this review focuses on what we should be trying to achieve in reaching goals to reduce repeated hospital readmission and mortality, and increase social activity and quality of life, especially in elderly patients with CHF. In these clinical settings, educational strategies for patients and their family members should be emphasised. Multidisciplinary interventions by nurses and possibly other contributions from a widely available social support system might be effective in preventing repeated hospital readmissions of elderly patients with CHF. In this regard, special precautions have to be paid in the management of elderly patients to achieve effective treatment goals, and any treatment strategy has to be appropriately determined through a comprehensive assessment of patient clinical profiles. Multidisciplinary approaches to these problems have to be effectively utilised to improve patients' quality of life, while possibly reducing medical expenses.
本文是一篇关于慢性代偿性充血性心力衰竭（CHF）的综述，特别提及了其临床特征、病理生理学以及药物治疗的最新进展，包括β受体阻滞剂、袢利尿剂、血管紧张素转换酶（ACE）抑制剂和血管紧张素II受体拮抗剂。还讨论了与老年患者相关的临床问题以及针对这些特殊患者的多学科医疗方法的多方面情况，特别强调了与降低死亡率相关的生活质量改善方面。在过去几十年里，CHF在病理生理学、自然病程、机制、死亡原因、心律失常和治疗目标等方面的概念发生了巨大变化。尽管目前CHF最常见的病因包括冠心病和扩张型心肌病，但高血压已被重新审视，并且在最近的趋势以及可能的未来展望中被认为至关重要。然而如今，通过各种适当的药物治疗，CHF患者在生存改善、症状缓解、功能能力提高以及预防包括左心室重塑在内的相关并发症方面都取得了成效，他们在身体和心理社会方面比以往任何时候都更加活跃。因此，改善患者生活质量和降低死亡率已成为实现治疗目标的首要任务。CHF的另一个新出现的方面是老龄化本身，在降低老年CHF患者再入院率以及改善发病率和死亡率的过程中，始终必须考虑到老年CHF患者医疗护理的特殊特征。尽管CHF治疗取得了进展，但它仍然是一种预后不良的常见疾病。因此，本综述重点关注我们在实现降低反复住院再入院率和死亡率、增加社交活动和生活质量的目标方面应该努力达成的内容，尤其是在老年CHF患者中。在这些临床环境中，应强调针对患者及其家庭成员的教育策略。护士的多学科干预以及广泛可用的社会支持系统可能做出的其他贡献，对于预防老年CHF患者反复住院再入院可能是有效的。在这方面，在管理老年患者以实现有效治疗目标时必须格外谨慎，并且任何治疗策略都必须通过对患者临床特征的全面评估来适当确定。必须有效利用针对这些问题的多学科方法来改善患者生活质量，同时可能降低医疗费用。
