Gheorghiade Mihai, Pang Peter S
Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
J Am Coll Cardiol. 2009 Feb 17;53(7):557-573. doi: 10.1016/j.jacc.2008.10.041.
Heart failure resulting in hospitalization represents a significant and growing health care burden. Heterogeneity characterizes this group in terms of mode of presentation, pathophysiology, and prognosis. The vast majority of patients symptomatically improve during hospitalization; however, their early post-discharge rehospitalization and mortality rates continue to be high. Worsening signs and symptoms, neurohormonal, and renal abnormalities occurring soon after discharge may contribute to these high post-discharge event rates. Currently available assessment modalities combined with recent advances in cardiovascular therapies provide present-day opportunities to improve post-discharge outcomes. Further investigation into pathophysiologic targets and novel approaches to clinical trial design are needed. Improving post-discharge outcomes is the single most important goal in the management of acute heart failure syndromes.
导致住院的心力衰竭是一个日益严重的重大医疗负担。该群体在临床表现方式、病理生理学和预后方面具有异质性。绝大多数患者在住院期间症状有所改善;然而,他们出院后的早期再住院率和死亡率仍然很高。出院后不久出现的症状和体征恶化、神经激素及肾脏异常可能是导致这些高出院后事件发生率的原因。目前可用的评估方法以及心血管治疗的最新进展为改善出院后结局提供了契机。需要进一步研究病理生理靶点以及临床试验设计的新方法。改善出院后结局是急性心力衰竭综合征管理中最重要的单一目标。