UMRS 942, Paris, France.
Arch Cardiovasc Dis. 2012 Jun-Jul;105(6-7):355-65. doi: 10.1016/j.acvd.2012.04.003. Epub 2012 Jun 28.
No clinical practice guidelines are available for the treatment of heart failure (HF) in patients with preserved left ventricular ejection fraction (LVEF).
To determine how cardiologists manage medical treatment in HF patients after hospital discharge, according to LVEF.
The FUTURE study was a cross-sectional survey conducted in HF outpatients by French private cardiologists between September 2007 and August 2008. Patients had to have been hospitalized within the previous 18 months with a diagnosis of HF. Clinical data and HF treatments (angiotensin-converting enzyme inhibitors [ACEIs], angiotensin receptor blockers [ARBs], beta-blockers, diuretics and aldosterone antagonists) were recorded retrospectively, with precise information on drug doses, at two successive time points (at hospital discharge and at the index consultation). HF treatment was compared in patients with reduced (less than or equal to 40%) versus preserved (more than 40%) LVEF.
Completed data were available for 1137 HF patients enrolled by 424 cardiologists. Mean patient age was 72±11 years; LVEF was reduced in 56% and preserved in 44%. The therapeutic approach was similar in the two groups, both at hospital discharge and at the index consultation. At the index consultation, HF treatment was: beta-blocker (74%); ACEI/ARB (83%); loop diuretic (86%); aldosterone antagonist (31%). The majority of patients (62%) received a beta-blocker plus an ACEI or an ARB; 56% reached more than or equal to 50% of the target dose for each treatment. There were no major differences in treatments and dosages between the groups with low and preserved LVEF. In 15% of cases where the drug dose was not increased, fear of adverse events was reported as the reason.
The FUTURE survey showed a similar approach to HF treatment irrespective of LVEF. Compared with previous studies, we saw an improvement in the use of recommended HF drugs, especially beta-blockers. However, achievement of target doses could be improved.
目前尚无针对射血分数保留的心力衰竭（HF）患者的临床实践指南。
根据左心室射血分数（LVEF），确定心脏病专家如何管理 HF 患者出院后的药物治疗。
FUTURE 研究是一项在 2007 年 9 月至 2008 年 8 月期间由法国私人心脏病专家对 HF 门诊患者进行的横断面调查。患者必须在过去 18 个月内因 HF 住院。回顾性记录临床数据和 HF 治疗（血管紧张素转换酶抑制剂[ACEI]、血管紧张素受体阻滞剂[ARB]、β受体阻滞剂、利尿剂和醛固酮拮抗剂），并在两个连续时间点（出院时和索引就诊时）记录药物剂量的详细信息。比较 LVEF 降低（≤40%）与保留（＞40%）的患者的 HF 治疗。
共纳入了 424 名心脏病专家的 1137 名 HF 患者，完成了数据。患者平均年龄为 72±11 岁；LVEF 降低的占 56%，保留的占 44%。两组患者在出院时和索引就诊时的治疗方法相似。在索引就诊时，HF 治疗为：β受体阻滞剂（74%）；ACEI/ARB（83%）；噻嗪类利尿剂（86%）；醛固酮拮抗剂（31%）。大多数患者（62%）接受了β受体阻滞剂加 ACEI 或 ARB；56%的患者达到了每种治疗的目标剂量的 50%以上。LVEF 降低和保留的两组之间，治疗和剂量没有明显差异。在未增加药物剂量的 15%病例中，报告的原因是担心不良反应。
FUTURE 调查显示，HF 治疗方法相似，与以往的研究相比，我们看到了推荐的 HF 药物的使用有所改善，尤其是β受体阻滞剂。然而，目标剂量的达标率还有待提高。
