Grigorian Shamagian Lilian, Varela Román Alfonso, Virgos Lamela Alejandro, Rigueiro Veloso Pedro, García Acuña José M, González-Juanatey José R
Servicio de Cardiología. Hospital Clínico Universitario de Santiago de Compostela. A Coruña. España.
Rev Esp Cardiol. 2005 Apr;58(4):381-8.
To evaluate changes in drug prescription during 1991-2002 in patients hospitalized for congestive heart failure (CHF) with preserved or depressed left ventricular (LV) systolic function.
A total of 1252 CHF patients (mean age, 69.4 (11.7) years; 61.3% male) hospitalized in a cardiology department were studied. Ischemic heart disease was present in 616 (49.2%), hypertension in 693 (55.4%), and diabetes in 335 (26.8%). Some 498 (39.8%) had preserved LV systolic function, defined as an echocardiographically determined ejection fraction > or =50% at admission. Pharmacotherapy at hospital discharge was recorded for all patients.
The changes in drug prescription observed in CHF patients with preserved LV systolic function paralleled those in patients with depressed LV systolic function. Change was influenced by the publication of major clinical trials on CHF and depressed LV systolic function. Consequently, the use of angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, and spironolactone progressively increased during follow-up for both types of CHF. Diuretics were prescribed for more than 70% of patients, with the rate being higher in those with depressed LV systolic function. Digoxin use decreased markedly in patients with preserved LV systolic function.
An increase in the prescription of drugs with proven effects on mortality and morbidity in patients with CHF was observed. Nevertheless, beta-blocker and spironolactone use remains suboptimal. The trend seen after hospitalization in CHF patients with preserved LV systolic function was similar, though slightly less marked.
评估1991年至2002年间因左心室（LV）收缩功能正常或降低的充血性心力衰竭（CHF）住院患者的药物处方变化。
对心内科住院的1252例CHF患者（平均年龄69.4（11.7）岁；61.3%为男性）进行了研究。616例（49.2%）患有缺血性心脏病，693例（55.4%）患有高血压，335例（26.8%）患有糖尿病。约498例（39.8%）患者左心室收缩功能正常，定义为入院时经超声心动图测定的射血分数≥50%。记录了所有患者出院时的药物治疗情况。
左心室收缩功能正常的CHF患者的药物处方变化与左心室收缩功能降低的患者相似。变化受到关于CHF和左心室收缩功能降低的主要临床试验发表的影响。因此，在两种类型的CHF随访期间，血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂、β受体阻滞剂和螺内酯的使用逐渐增加。超过70%的患者使用了利尿剂，左心室收缩功能降低的患者使用率更高。左心室收缩功能正常的患者地高辛使用显著减少。
观察到对CHF患者死亡率和发病率有已证实疗效的药物处方有所增加。然而，β受体阻滞剂和螺内酯的使用仍未达到最佳水平。左心室收缩功能正常的CHF患者住院后的趋势相似，尽管不太明显。
