西班牙对欧洲心脏病学会心力衰竭治疗指南的遵循情况：欧洲心脏病学会心力衰竭长期注册研究
Adherence to the ESC Heart Failure Treatment Guidelines in Spain: ESC Heart Failure Long-term Registry.
作者信息
Crespo-Leiro María G, Segovia-Cubero Javier, González-Costello José, Bayes-Genis Antoni, López-Fernández Silvia, Roig Eulàlia, Sanz-Julve Marisa, Fernández-Vivancos Carla, de Mora-Martín Manuel, García-Pinilla José Manuel, Varela-Román Alfonso, Almenar-Bonet Luis, Lara-Padrón Antonio, de la Fuente-Galán Luis, Delgado-Jiménez Juan
机构信息
Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña (UDC), A Coruña, Spain.
Unidad de Insuficiencia Cardiaca Avanzada, Trasplante e Hipertensión Pulmonar, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
出版信息
Rev Esp Cardiol (Engl Ed). 2015 Sep;68(9):785-93. doi: 10.1016/j.rec.2015.03.008. Epub 2015 May 21.
INTRODUCTION AND OBJECTIVES
To estimate the percentage of heart failure patients in Spain that received the European Society of Cardiology recommended treatments, and in those that did not, to determine the reasons why.
METHODS
The study included 2834 consecutive ambulatory patients with heart failure from 27 Spanish hospitals. We recorded general information, the treatment indicated, and the reasons why it was not prescribed in some cases. In patients who met the criteria to receive a certain drug, true undertreatment was defined as the percentage of patients who, without justification, did not receive the drug.
RESULTS
In total, 92.6% of ambulatory patients with low ejection fraction received angiotensin converting enzyme inhibitors or angiotensin receptor blockers, 93.3% beta-blockers, and 74.5% mineralocorticoid receptor antagonists. The true undertreatment rates were 3.4%, 1.8%, and 19.0%, respectively. Target doses were reached in 16.2% of patients receiving angiotensin converting enzyme inhibitors, 23.3% of those with angiotensin receptor blockers, 13.2% of those prescribed beta-blockers, and 23.5% of those with mineralocorticoid receptor antagonists. Among patients who could benefit from ivabradine, 29.1% received this drug. In total, 36% of patients met the criteria for defibrillator implantation and 90% of them had received the device or were scheduled for implantation, whereas 19.6% fulfilled the criteria for resynchronization therapy and 88.0% already had or would soon have the device. In patients who met the criteria, but did not undergo device implantation, the reasons were not cost-related.
CONCLUSIONS
When justified reasons for not administering heart failure drugs were taken into account, adherence to the guideline recommendations was excellent. Exclusive use of the percentage of treated patients is a poor indicator of the quality of healthcare in heart failure. Measures should be taken to improve the attainment of optimal dosing in each patient.
引言与目标
估算西班牙接受欧洲心脏病学会推荐治疗的心力衰竭患者比例，并确定未接受推荐治疗的患者未接受治疗的原因。
方法
该研究纳入了来自西班牙27家医院的2834例连续性门诊心力衰竭患者。我们记录了一般信息、推荐的治疗方法以及某些情况下未开具该治疗方法的原因。在符合使用某种药物标准的患者中，真正的治疗不足定义为无故未接受该药物治疗的患者比例。
结果
总体而言，92.6%的低射血分数门诊患者接受了血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂治疗，93.3%接受了β受体阻滞剂治疗，74.5%接受了盐皮质激素受体拮抗剂治疗。真正的治疗不足率分别为3.4%、1.8%和19.0%。接受血管紧张素转换酶抑制剂治疗的患者中，16.2%达到了目标剂量；接受血管紧张素受体阻滞剂治疗的患者中，23.3%达到了目标剂量；接受β受体阻滞剂治疗的患者中，13.2%达到了目标剂量；接受盐皮质激素受体拮抗剂治疗的患者中，23.5%达到了目标剂量。在可从伊伐布雷定中获益的患者中，29.1%接受了该药物治疗。总体而言，36%的患者符合植入除颤器的标准，其中90%已接受该设备或计划植入，而19.6%符合心脏再同步治疗标准，88.0%已拥有或即将拥有该设备。在符合标准但未进行设备植入的患者中，原因与费用无关。
结论
当考虑到未使用心力衰竭药物的合理原因时，对指南建议的依从性良好。仅使用接受治疗患者的比例是心力衰竭医疗质量的一个较差指标。应采取措施提高每位患者达到最佳剂量的比例。
Zotero 插件