Gheorghiade Mihai, Albert Nancy M, Curtis Anne B, Thomas Heywood J, McBride Mark L, Inge Patches Johnson, Mehra Mandeep R, O'Connor Christopher M, Reynolds Dwight, Walsh Mary Norine, Yancy Clyde W, Fonarow Gregg C
Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Congest Heart Fail. 2012 Jan-Feb;18(1):9-17. doi: 10.1111/j.1751-7133.2011.00250.x. Epub 2011 Sep 19.
Eligible outpatients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF) frequently do not receive target doses of HF medications. The Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) evaluated the effect of a practice-based performance improvement intervention on treatment of outpatients with LVEF ≤35%. Specific agent and dose were collected at baseline and 24 months for angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs), β-blockers, and aldosterone antagonists. Changes in dosing over time were analyzed for each medication class. Data were available for 7605 patients. At baseline, target dose treatment rates were 36.1%, 20.5%, and 74.4%, respectively. Absolute and relative improvements of 9.8% and 47.7% ( P<.001) were achieved for β-blocker dosing at 24 months. The IMPROVE HF intervention was associated with significantly increased treatment of eligible patients with target doses of β-blockers but not ACE inhibitors/ARBs or aldosterone antagonists. Additional research to determine barriers to use of target doses of HF medications may be necessary.
符合条件的左心室射血分数（LVEF）降低的心力衰竭（HF）门诊患者常常无法接受HF药物的目标剂量治疗。门诊环境中改善基于证据的心力衰竭治疗使用情况登记研究（IMPROVE HF）评估了一项基于实践的绩效改进干预措施对LVEF≤35%的门诊患者治疗的影响。在基线期和24个月时收集了血管紧张素转换酶（ACE）抑制剂/血管紧张素受体阻滞剂（ARB）、β受体阻滞剂和醛固酮拮抗剂的确切药物及剂量。对每个药物类别随时间的剂量变化进行了分析。有7605例患者的数据可用。在基线期，目标剂量治疗率分别为36.1%、20.5%和74.4%。在24个月时，β受体阻滞剂剂量的绝对改善和相对改善分别达到9.8%和47.7%（P<0.001）。IMPROVE HF干预措施与使用目标剂量β受体阻滞剂治疗符合条件的患者显著增加相关，但与ACE抑制剂/ARB或醛固酮拮抗剂无关。可能需要进行更多研究以确定使用HF药物目标剂量的障碍。
