Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA 90095-1679, USA.
Am Heart J. 2011 Jun;161(6):1024-30.e3. doi: 10.1016/j.ahj.2011.01.027.
Although multiple therapies have been shown to lower mortality in patients with heart failure (HF) and reduced left ventricular ejection fraction, their application in clinical practice has been less than ideal. To date, empiric estimation of the potential benefits that could be gained from eliminating these existing treatment gaps with optimal implementation has not been quantified.
Eligibility criteria for each evidence-based HF therapy, the estimated frequency of use/nonuse of specific treatments, the case fatality rates, and the risk reductions due to treatment were obtained from published sources. The numbers of deaths prevented or postponed because of each guideline-recommended therapy and overall were determined.
Among patients with HF with reduced left ventricular ejection fraction in the United States (n = 2,644,800), the number eligible but not currently treated ranged from 139,749 for hydralazine/isorbide dinitrate to 852,512 for implantable cardioverter defibrillators. The comparative number of deaths that could potentially be prevented per year with optimal implementation of angiotensin-converting enzyme inhibitor/angiotensin receptor antagonist is 6,516; β-blockers, 12,922; aldosterone antagonists, 21,407; hydralazine/isorbide dinitrate, 6,655; cardiac resynchronization therapy, 8,317; and implantable cardioverter defibrillators, 12,179. If these treatment benefits were additive, optimal implementation of all 6 therapies could potentially prevent 67,996 deaths a year.
A substantial number of HF deaths in this country could potentially be prevented by optimal implementation of evidence-based therapies. These data may underscore the importance of performance improvement efforts to translate evidence-based therapy to routine clinical practice so as to reduce contemporary HF mortality.
多项疗法已被证实可降低射血分数降低的心力衰竭（HF）患者的死亡率，但这些疗法在临床实践中的应用并不理想。迄今为止，尚未对通过最佳实施消除这些现有治疗差距可能获得的潜在益处进行经验估计。
从已发表的资料中获得了每项基于证据的 HF 治疗的入选标准、特定治疗方法的使用/未使用的估计频率、病死率以及治疗带来的风险降低。确定了由于每种指南推荐的治疗方法而避免或推迟的死亡人数以及总的死亡人数。
在美国射血分数降低的 HF 患者中（n=2644800），未得到当前治疗的合格患者人数从肼屈嗪/硝酸异山梨酯的 139749 例到植入式心脏复律除颤器的 852512 例不等。每年通过最佳实施血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂潜在预防的死亡人数为 6516 例；β受体阻滞剂为 12922 例；醛固酮拮抗剂为 21407 例；肼屈嗪/硝酸异山梨酯为 6655 例；心脏再同步治疗为 8317 例；植入式心脏复律除颤器为 12179 例。如果这些治疗益处具有累加性，那么最佳实施所有 6 种治疗方法每年可能预防 67996 例死亡。
通过最佳实施基于证据的疗法，该国可能会预防大量 HF 死亡。这些数据可能强调了改进绩效的重要性，以将基于证据的治疗方法转化为常规临床实践，从而降低当代 HF 死亡率。
