Teo K K, Ignaszewski A P, Gutierrez R, Hill K L, Martin S L, Calhoun H P, Humen D P, Montague T J
Epidemiology Coordinating and Research (EPICORE) Centre, University of Alberta, Edmonton.
Can J Cardiol. 1992 Jul-Aug;8(6):611-9.
The primary purpose of this review was to address the following question: based on the best available evidence, what should be the current medical management of congestive heart failure (CHF)?
The major sources for this review were from searches of the English language literature, including computer and bibliography reviews, of all randomized, controlled clinical trials and overview analyses of positive inotropic agents, preload/afterload reduction agents and beta-blocker medications in CHF.
The number of studies reviewed was approximately 40. The major criterion for selection was that the studies be of CHF patients in randomized controlled clinical trials, particularly with a mortality/survival endpoint. Additional clinical trials of nonmortality endpoints in CHF patients and mortality trials in non-CHF patients were also selected to support possible pathophysiological insights for future CHF trials.
The data, particularly for the accompanying tables, were initially extracted by a single reviewer using common qualitative guidelines as far as was possible within the different temporal, etiological and geographic frameworks of the original component studies. Conclusions are drawn from this data synthesis and from published overviews.
Angiotensin converting enzyme (ACE) inhibition therapy is effective in reducing mortality and morbidity in severe left ventricular dysfunction and CHF. Other systemic vasodilators may also be beneficial. The effects of digitalis on survival and morbidity in CHF are presently uncertain, but should be resolved in the near future. Other inotropic agents, at least in the long term, are clinically detrimental. Diuretics decrease morbidity, but their effect on mortality in CHF remains unknown. Beta-blocker and magnesium therapy offer promise in CHF, but await definitive clinical trials evaluation.
The current medical therapy of CHF should definitely include ACE inhibitors, probably diuretics and possibly other vasodilators. Further viable trials of promising new, and older heretofore under-evaluated, CHF therapies are needed. Additionally, innovative strategies are needed to deal with this disease which has an increasing prevalence. Two strategies, primary prevention of CHF and a 'Heart Function Clinic', are discussed.
本综述的主要目的是回答以下问题：基于现有最佳证据，目前充血性心力衰竭（CHF）的药物治疗应该是什么？
本综述的主要数据来源是对英文文献的检索，包括计算机检索和文献综述，涵盖所有关于CHF中强心剂、前负荷/后负荷降低剂和β受体阻滞剂药物的随机对照临床试验及综述分析。
所综述的研究数量约为40项。主要选择标准是这些研究为CHF患者的随机对照临床试验，特别是具有死亡率/生存终点的试验。还选择了CHF患者非死亡率终点的其他临床试验以及非CHF患者的死亡率试验，以支持对未来CHF试验可能的病理生理学见解。
数据，特别是对于附表，最初由一名审阅者根据原始组成研究不同的时间、病因和地理框架内尽可能通用的定性指南进行提取。结论来自于该数据综合以及已发表的综述。
血管紧张素转换酶（ACE）抑制疗法可有效降低严重左心室功能不全和CHF的死亡率和发病率。其他全身性血管扩张剂可能也有益处。洋地黄对CHF患者生存和发病率的影响目前尚不确定，但在不久的将来应该会有定论。其他强心剂，至少从长期来看，在临床上是有害的。利尿剂可降低发病率，但它们对CHF患者死亡率的影响仍不清楚。β受体阻滞剂和镁剂疗法在CHF治疗中显示出前景，但有待确定性临床试验评估。
目前CHF的药物治疗肯定应包括ACE抑制剂，可能还包括利尿剂以及其他血管扩张剂。需要对有前景的新的以及以前评估不足的CHF疗法进行进一步可行的试验。此外，需要创新策略来应对这种患病率不断上升的疾病。讨论了两种策略，即CHF的一级预防和“心功能诊所”。
