Drechsler K, Dietz R, Klein H, Wollert K C, Storp D, Molling J, Zeymer U, Niebauer J
Universität Leipzig-Herzzentrum, Leipzig, Germany.
Z Kardiol. 2005 Aug;94(8):510-5. doi: 10.1007/s00392-005-0245-y.
It was the aim of the Euro Heart Survey on Heart Failure to assess whether patients are being treated according to current guidelines.
In Germany, patients were screened in 7 medical centers if their discharge diagnoses were myocardial infarction, a new episode of atrial fibrillation, or diabetes mellitus. Patients were enrolled if at least one additional criterion was fulfilled: (1) clinical diagnosis of heart failure, (2) hospital admission due to heart failure within the last 3 years, (3) therapy with loop diuretic, (4) medication for heart failure or ventricular dysfunction documented by echocardiography within the past 24 hours prior to death.
2166 patients were screened of whom 747 were included in the study (478 men, 269 women). 93% of the patients suffered from heart failure. Despite the high number of patients with known heart failure (ischemic heart failure in 71%), only 72% received ACE inhibitors and 62% beta-blockers. Average daily dose met recommendations in only 63% of patients on ACE inhibitors and 54% on beta-blockers. 74% of the patients received diuretics (furosemide 36%, thiazide 34%, spironolactone 17%).
An inadequately low number of patients with heart failure receives medical therapy according to guidelines, despite all the overwhelming evidence for improved morbidity and mortality. Awareness of physicians needs to be improved.
欧洲心力衰竭调查的目的是评估患者是否按照现行指南接受治疗。
在德国，若患者的出院诊断为心肌梗死、新发房颤或糖尿病，则在7个医疗中心进行筛查。若至少满足一项附加标准，则纳入患者：（1）心力衰竭临床诊断；（2）过去3年内因心力衰竭住院；（3）使用袢利尿剂治疗；（4）在死亡前24小时内超声心动图记录有心力衰竭或心室功能障碍的用药情况。
共筛查2166例患者，其中747例纳入研究（478例男性，269例女性）。93%的患者患有心力衰竭。尽管已知心力衰竭的患者数量众多（71%为缺血性心力衰竭），但只有72%的患者接受了ACE抑制剂治疗，62%的患者接受了β受体阻滞剂治疗。ACE抑制剂治疗患者中只有63%、β受体阻滞剂治疗患者中只有54%的平均日剂量符合推荐。74%的患者接受了利尿剂治疗（速尿36%，噻嗪类34%，螺内酯17%）。
尽管有充分证据表明可改善发病率和死亡率，但心力衰竭患者接受指南推荐药物治疗的人数仍然不足。医生的认知需要提高。
