与心力衰竭患者临床实践中心脏射血分数改善相关的因素：来自 IMPROVE HF 的研究结果。
Factors associated with improvement in ejection fraction in clinical practice among patients with heart failure: findings from IMPROVE HF.
机构信息
Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
出版信息
Am Heart J. 2012 Jan;163(1):49-56.e2. doi: 10.1016/j.ahj.2011.10.001.
BACKGROUND
Available data suggest that improvement in left ventricular ejection fraction (LVEF) is a major predictor of improved survival in heart failure (HF). Although certain factors are associated with improvements in LVEF in select patients with HF enrolled in clinical trials, relatively little is known about such factors among patients in clinical practice. This study evaluated changes in LVEF and associated factors in outpatients with systolic HF or post-myocardial infarction with reduced LVEF during 24 months of follow-up.
METHODS
IMPROVE HF is a prospective evaluation of a practice-based performance improvement intervention implemented at outpatient cardiology/multispecialty practices to increase use of guideline-recommended care for eligible patients. Data were analyzed by patient groups based on absolute improvement in LVEF (<0%, 0-≤10%, and >10%) from baseline to 24 months and by change in LVEF as a continuous variable.
RESULTS
A total of 3,994 patients from 155 of 167 practices were eligible for analysis. The overall mean LVEF increased from 25.8% at baseline to 32.3% (+6.4%) at 24 months (P < .001), and 28.6% of patients had a >10% improvement in ejection fraction (from 24.5% to 46.2%, 92% relative improvement). Age, race, and practice setting were similar between the 3 LVEF improvement groups. Multivariate analysis revealed female sex, no prior myocardial infarction, nonischemic HF etiology, and no digoxin use were associated with >10% improvement in LVEF.
CONCLUSIONS
Among patients with HF receiving care in cardiology/multispecialty practices participating in a performance measure intervention, surviving, and having repeat LVEF assessment, close to one third of patients had a >10% improvement in LVEF at 24 months. These findings indicate that HF is not always a progressive disease and that differentiation of the heterogeneous HF phenotypes may set the stage for future research and therapeutic targets.
背景
现有数据表明，左心室射血分数（LVEF）的改善是心力衰竭（HF）患者生存率提高的主要预测因素。尽管某些因素与临床试验中特定 HF 患者的 LVEF 改善有关，但在临床实践中，人们对这些因素知之甚少。本研究评估了 24 个月随访期间接受射血分数降低的收缩性心力衰竭或心肌梗死后心力衰竭治疗的门诊患者的 LVEF 变化及其相关因素。
方法
IMPROVE HF 是对基于实践的绩效改进干预措施的前瞻性评估，该干预措施在门诊心脏病学/多专科实践中实施，以增加对符合条件患者的指南推荐护理的使用。根据 LVEF 从基线到 24 个月的绝对改善（<0%、0-≤10%和>10%），以及 LVEF 作为连续变量的变化，对患者进行分组分析。
结果
共有来自 167 个实践中的 155 个实践的 3994 名患者符合分析条件。总体平均 LVEF 从基线时的 25.8%增加到 24 个月时的 32.3%（+6.4%）（P<0.001），28.6%的患者射血分数增加>10%（从 24.5%增加到 46.2%，相对增加 92%）。在 3 个 LVEF 改善组中，年龄、种族和实践环境相似。多变量分析显示，女性、无既往心肌梗死、非缺血性 HF 病因和未使用地高辛与 LVEF 增加>10%有关。
结论
在接受心脏病学/多专科实践护理并参加绩效衡量干预的 HF 患者中，存活并重复进行 LVEF 评估的患者中，近三分之一的患者在 24 个月时 LVEF 增加>10%。这些发现表明，HF 并不总是一种进行性疾病，HF 异质表型的区分可能为未来的研究和治疗目标奠定基础。
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