Howard Patricia A, Cheng Judy W M, Crouch Michael A, Colucci Vincent J, Kalus James S, Spinler Sarah A, Munger Mark
Department of Pharmacy Practice, University of Kansas Medical Center, Kansas City, KS 66160-7231, USA.
Ann Pharmacother. 2006 Sep;40(9):1607-17. doi: 10.1345/aph.1H059. Epub 2006 Aug 8.
To review and discuss key aspects of the drug therapy recommendations in the American College of Cardiology (ACC)/American Heart Association (AHA) 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure (HF) in the Adult.
Data were obtained from the ACC/AHA 2005 Guideline Update for Chronic HF. English-language clinical trials, observational studies, and pertinent review articles evaluating the pharmacotherapy of chronic HF were identified, based on MEDLINE searches through January 2006.
Articles presenting information that impacts the evidence base for recommendations regarding the use of various drug therapies in patients with chronic HF were evaluated.
The ACC/AHA 2005 Guideline Update for HF provides revised, evidence-based recommendations for the treatment of chronic HF. The new guidelines are based on a staging system that recognizes both the development and progression of HF. Recommendations are provided for 2 stages of patients (A and B) who do not yet have clinical HF but are clearly at risk and 2 stages (C and D) that include patients with symptomatic HF. The guidelines continue to emphasize the important role of neurohormonal blockade with angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-adrenergic blockers, and aldosterone antagonists. Based on recent trials, updated recommendations address the roles of combination therapy and the selective addition of hydralazine and isosorbide dinitrate. Along with specific drug recommendations, information on the practical use of various drugs is provided. Although the guidelines primarily focus on HF due to systolic dysfunction, general recommendations are also provided for patients with preserved systolic function.
The ACC/AHA 2005 Guideline Update provides evidence-based recommendations for healthcare professionals involved in the care of adults with chronic HF. Recent clinical trial findings have further clarified the evolving role of neurohormonal-blocking drugs in the prevention and treatment of HF.
回顾并讨论美国心脏病学会（ACC）/美国心脏协会（AHA）《2005年成人慢性心力衰竭（HF）诊断和管理指南更新》中药物治疗建议的关键方面。
数据取自ACC/AHA《2005年慢性HF指南更新》。通过检索截至2006年1月的MEDLINE，识别出评估慢性HF药物治疗的英文临床试验、观察性研究及相关综述文章。
评估了提供影响慢性HF患者各种药物治疗建议证据基础信息的文章。
ACC/AHA《2005年HF指南更新》为慢性HF的治疗提供了经修订的、基于证据的建议。新指南基于一个认识到HF发生和进展的分期系统。针对尚无临床HF但明显有风险的2个阶段（A和B）患者以及包括有症状HF患者的2个阶段（C和D）提供了建议。指南继续强调血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂、β肾上腺素能阻滞剂和醛固酮拮抗剂进行神经激素阻断的重要作用。基于近期试验，更新后的建议涉及联合治疗的作用以及肼屈嗪和硝酸异山梨酯的选择性添加。除了具体的药物建议外，还提供了各种药物实际应用的信息。尽管指南主要关注收缩功能不全导致的HF，但也为收缩功能保留的患者提供了一般建议。
ACC/AHA《2005年指南更新》为参与成人慢性HF护理的医护人员提供了基于证据的建议。近期临床试验结果进一步阐明了神经激素阻断药物在HF预防和治疗中不断演变的作用。
