Dokainish Hisham, Jewett Lauren, Nieuwlaat Robby, Coulson Joshua, Demers Catherine, Lonn Eva, Healey Jeff, Haynes Brian, Connolly Stuart
Division of Cardiology, Department of Medicine and the Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Open Cardiovasc Med J. 2014 Sep 30;8:94-101. doi: 10.2174/1874192401408010094. eCollection 2014.
To assess gaps between guidelines and medicine prescription/dosing and referral for defibrillator therapy in patients with left ventricular systolic dysfunction (LVSD).
Outpatient echocardiography reports at an academic hospital centre were screened and outpatients with LVEF<40% were included. A questionnaire was mailed to the patients' physician, querying prescription/dosing of ACE-inhibitors (ACEi), angiotensin receptor blockers (ARB) and beta-blockers (BB). Patients with LVEF<30% had additional questions on implantable cardiac defibrillator (ICD) referral.
Mean age was 69.6+/-12.2 years and mean LVEF was 29.7+/-6.5%. ACEi and/or ARB prescription rate was 260/309(84.1%) versus 256/308(83.1%) for BB (p=NS for comparison). Of patients on ACEi, 77/183(42.1%) were on target dose, compared to 7/45(15.5%) for ARB and 9/254(3.5%) for BB (p<0.01). Of 171/309 patients (55.3%) with LVEF<30%, 72/171(42.1%) had an ICD and 16/171(9.4%) were referred for one.
Prescription rates of evidence-based HF medicines are relatively high in outpatients with LVSD referred for echocardiography at this Canadian academic medical centre; however, the proportion of patients at target doses was modest for ACEi and low for ARB and BB. Approximately half of patients who qualify for ICD by EF alone have one or were referred. Important reasons for patients with LVSD not on evidence-based therapy were identified.
评估左心室收缩功能障碍（LVSD）患者在指南与除颤器治疗的药物处方/剂量及转诊方面的差距。
筛选一家学术医院中心的门诊超声心动图报告，纳入左心室射血分数（LVEF）<40%的门诊患者。向患者的医生邮寄一份问卷，询问血管紧张素转换酶抑制剂（ACEi）、血管紧张素受体阻滞剂（ARB）和β受体阻滞剂（BB）的处方/剂量情况。LVEF<30%的患者还被问及植入式心脏除颤器（ICD）转诊的相关问题。
平均年龄为69.6±12.2岁，平均LVEF为29.7±6.5%。ACEi和/或ARB的处方率为260/309（84.1%），BB为256/308（83.1%）（比较时p=无显著差异）。使用ACEi的患者中，77/183（42.1%）达到目标剂量，ARB为7/45（15.5%），BB为9/254（3.5%）（p<0.01）。在309例LVEF<30%的患者中，171例（55.3%），72/171（42.1%）有ICD，16/171（9.4%）被转诊接受ICD治疗。
在这家加拿大学术医学中心，因超声心动图检查而转诊的LVSD门诊患者中，循证性心力衰竭药物的处方率相对较高；然而，达到目标剂量的患者比例，ACEi适中，ARB和BB较低。仅根据射血分数符合ICD植入条件的患者中，约一半已植入或已被转诊。确定了LVSD患者未接受循证性治疗的重要原因。
