Department of Health Services Research, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands.
Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands.
J Geriatr Cardiol. 2016 Jan;13(1):44-50. doi: 10.11909/j.issn.1671-5411.2016.01.001.
For the treatment of chronic heart failure (HF), both pharmacological and non-pharmacological treatment should be employed in HF patients. Although HF is highly prevalent in nursing home residents, it is not clear whether the recommendations in the guidelines for pharmacological therapy also are followed in nursing home residents. The aim of this study is to investigate how HF is treated in nursing home residents and to determine to what extent the current treatment corresponds to the guidelines.
Nursing home residents of five large nursing home care organizations in the southern part of the Netherlands with a previous diagnosis of HF based on medical records irrespective of the left ventricle ejection fraction (LVEF) were included in this cross-sectional design study. Data were gathered on the (medical) records, which included clinical characteristics and pharmacological- and non-pharmacological treatment. Echocardiography was used as part of the study to determine the LVEF.
Out of 501 residents, 112 had a diagnosis of HF at inclusion. One-third of them received an ACE-inhibitor and 40% used a β-blocker. In 66%, there was a prescription of diuretics with a preference of a loop diuretic. Focusing on the residents with a LVEF ≤ 40%, only 46% of the 22 residents used an ACE-inhibitor and 64% a β-blocker. The median daily doses of prescribed medication were lower than those that were recommended by the guidelines. Non-pharmacological interventions were recorded in almost none of the residents with HF.
The recommended medical therapy of HF was often not prescribed; if prescribed, the dosage was usually far below what was recommended. In addition, non-pharmacological interventions were mostly not used at all.
对于慢性心力衰竭（HF）的治疗，HF 患者应同时采用药物和非药物治疗。尽管养老院居民中 HF 的患病率很高，但目前尚不清楚指南中推荐的药物治疗建议是否也适用于养老院居民。本研究旨在调查养老院居民中 HF 的治疗方法，并确定当前治疗与指南的符合程度。
本横断面设计研究纳入了荷兰南部五家大型养老院护理组织的养老院居民，这些居民之前根据病历被诊断为 HF，而不管左心室射血分数（LVEF）如何。收集了包括临床特征以及药物和非药物治疗在内的病历数据。使用超声心动图来确定 LVEF。
在 501 名居民中，有 112 人在纳入时被诊断为 HF。其中三分之一接受了 ACE 抑制剂治疗，40%使用了β受体阻滞剂。在 66%的患者中，开具了利尿剂处方，其中更倾向于开环利尿剂。在 LVEF≤40%的居民中，只有 46%的 22 名居民使用 ACE 抑制剂，64%使用β受体阻滞剂。处方药物的日剂量中位数低于指南推荐的剂量。几乎没有 HF 患者接受非药物干预。
HF 的推荐药物治疗方案通常未被开具；如果开具了处方，剂量通常远低于指南推荐的剂量。此外，非药物干预措施基本上根本未被使用。
