Abarquez Ramon F, Reganit Paul Ferdinand M, Chungunco Carmen N, Alcover Jean, Punzalan Felix Eduardo R, Reyes Eugenio B, Cunanan Elleen L
Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines.
ASEAN Heart J. 2016 Mar 8;24(1):4. doi: 10.7603/s40602-016-0004-5. eCollection 2016 Mar.
Chronic heart failure (HF) disease as an emerging epidemic has a high economic-psycho-social burden, hospitalization, readmission, morbidity and mortality rates despite many clinical practice guidelines' evidenced-based and consensus driven recommendations that include trials' initial-baseline data.
To show that the survival and hospitalization-free event rates in the reviewed chronic HF clinical practice guidelines' class I-A recommendations as initial HF drug therapy (IDT) is possibly a combination and 'start-to-end' synergistic effect of the add-on ('end') HF drug therapy (ADT) to the baseline ('start') HF drug therapy (BDT).
The references cited in the chronic HF clinical practice guidelines of the 2005, 2009, and 2013 American Heart Association/American College of Cardiology (AHA/ACC), the 2006 Heart Failure Society of America (HFSA), and the 2005, 2008, and 2012 European Society of Cardiology (ESC) were reviewed and compared with the respective guidelines' and other countries' recommendations.
The BDT using glycosides and diuretics is 79%-100% in the cited HF trials. The survival rates attributed to the BDT ('start') is 46%-89% and IDT ('end') 61%-92.8%, respectively. The hospitalization-free event rate of the BDT group: 47.1% to 85.3% and IDT group 61.8%-90%, respectively. Thus, the survival and hospitalization-free event rates of the ADT is 0.4%-15% and 4.6% to 14.7%, respectively. The extrapolated BDT survival is 8%-51% based on a 38% estimated natural HF survival rate for the time period109.
The contribution of baseline HF drug therapy (BDT) is relevant in terms of survival and hospitalization-free event rates compared to the HF class 1-A guidelines initial drug therapy recommendations (IDT). Further, the proposed initial HF drug ('end') therapy (IDT) has possible synergistic effects with the baseline HF drug ('start') therapy (BDT) and is essentially the add on HF drug therapy (ADT) in our analysis. The polypharmacy HF treatment is a synergistic effect due to BDT and ADT.
慢性心力衰竭（HF）作为一种新出现的流行病，尽管有许多临床实践指南基于证据和共识提出了包括试验初始基线数据在内的建议，但仍具有很高的经济、心理和社会负担、住院率、再入院率、发病率和死亡率。
表明在已审查的慢性HF临床实践指南中作为初始HF药物治疗（IDT）的I-A类推荐中的生存和无住院事件率可能是附加（“结束”）HF药物治疗（ADT）对基线（“开始”）HF药物治疗（BDT）的一种组合和“从头到尾”的协同效应。
对2005年、2009年和2013年美国心脏协会/美国心脏病学会（AHA/ACC）、2006年美国心力衰竭学会（HFSA）以及2005年、2008年和2012年欧洲心脏病学会（ESC）的慢性HF临床实践指南中引用的参考文献进行了审查，并与各自指南以及其他国家的建议进行了比较。
在引用的HF试验中，使用糖苷和利尿剂的BDT为79%-100%。归因于BDT（“开始”）的生存率分别为46%-89%，IDT（“结束”）的生存率为61%-92.8%。BDT组的无住院事件率为47.1%至85.3%，IDT组为61.8%-90%。因此，ADT的生存和无住院事件率分别为0.4%-15%和4.6%至14.7%。基于该时间段109的估计自然HF生存率38%，推断出的BDT生存率为8%-51%。
与HF 1-A类指南的初始药物治疗建议（IDT）相比，基线HF药物治疗（BDT）在生存和无住院事件率方面的贡献是相关的。此外，提议的初始HF药物（“结束”）治疗（IDT）与基线HF药物（“开始”）治疗（BDT）可能具有协同效应，并且在我们的分析中本质上是附加HF药物治疗（ADT）。HF的多药治疗是BDT和ADT产生的协同效应。
