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[匈牙利心力衰竭注册研究2015 - 2016年。初步结果]

[Hungarian Heart Failure Registry 2015-2016. Preliminary results].

作者信息

Nyolczas Noémi, Heltai Krisztina, Borbély Attila, Habon Tamás, Járai Zoltán, Sziliczei Erzsébet, Stadler Péter, Faludi Réka, Herczeg Béla, Papp Előd, Lakatos Ferenc, Nagy Katalin, Katona András, Kovács Imre, Tomcsányi János, Nagy András, Sepp Róbert

机构信息

Magyar Honvédség Egészségügyi Központ Budapest, Róbert Károly krt. 44., 1134.

Városmajori Szív- és Érgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest.

出版信息

Orv Hetil. 2017 Jan;158(3):94-100. doi: 10.1556/650.2017.30671.

Abstract

Heart failure is associated with a poor prognosis despite significant advances in the pharmacological and device therapy and incurs very high cost because of frequent hospitalizations. Therefore, professional high-quality care is essential for both patients and the healthcare system. The best way to evaluate the quality of care for a particular disease is the use of disease-specific registries. Until now, there has not been a registry evaluating characteristics and management of heart failure patients in Hungary. For that reason, the Hungarian Society of Cardiology initiated the set-up of the Hungarian Heart Failure Registry. The Aim of this paper is to present the goals, methods and first year results of the Hungarian Heart Failure Registry. The goal of the Registry is to create a modern, web-based database that summarizes the data of large number of patients who are currently or were previously admitted to hospital or who are currently or were previously patients in an outpatient department due to severe heart failure (NYHA III-IV). Currently 17 cardiology departments participate in the development of the Registry. The planned number of patients is 2000. Initially follow-up was planned for one year (pilot study). After the evaluation of the relevant experiences of the pilot study, long-term follow-up is planned. The Registry collects information about the type of heart failure (heart failure with reduced - LVEF≤45% - vs. preserved - LVEF>45% - ejection fraction), etiology, co-morbidities, diagnostic methods, treatment as well as morbidity and mortality. After the first year, assessing the baseline parameters of 698 patients enrolled in the Registry we found that the majority of patients (87.8%) has heart failure with reduced ejection fraction and in 39.8% of the patients heart failure has an ischaemic origin. The most frequent co-morbidity was hypertension followed by diabetes, renal insufficiency and COPD. The patients were treated with ACE inhibitors or ARBs in 94.4%, with beta blockers in 95.9%, and mineralocorticoid receptor antagonists in 73.9%. The mean dose of neurohormonal antagonists was higher than half of the target dose defined by current guidelines. The use of cardiac resynchronisation therapy was 11.7% and implantable cardioverter defibrillator was 25.8%. The pharmacological and device therapy of patients who were enrolled in the Registry until now was fit the current guidelines' recommendations. This, however, does not mean that the management of heart failure is without problems in our country but that high quality patient care is available with adequate heart failure treatment in cardiology departments dedicated to heart failure care. Orv. Hetil., 2017, 158(3), 94-100.

摘要

尽管在药物治疗和器械治疗方面取得了显著进展,但心力衰竭的预后仍然较差,且由于频繁住院,费用高昂。因此,专业的高质量护理对患者和医疗系统都至关重要。评估特定疾病护理质量的最佳方法是使用特定疾病登记系统。到目前为止,匈牙利尚未有一个登记系统来评估心力衰竭患者的特征和管理情况。因此,匈牙利心脏病学会发起了匈牙利心力衰竭登记系统的建立。本文旨在介绍匈牙利心力衰竭登记系统的目标、方法和第一年的结果。该登记系统的目标是创建一个基于网络的现代数据库,汇总大量因严重心力衰竭(纽约心脏协会III-IV级)目前或既往住院或目前或既往在门诊就诊的患者的数据。目前有17个心脏病学部门参与该登记系统的开发。计划纳入的患者数量为2000名。最初计划进行一年的随访(试点研究)。在评估试点研究的相关经验后,计划进行长期随访。该登记系统收集有关心力衰竭类型(射血分数降低的心力衰竭-LVEF≤45%-与射血分数保留的心力衰竭-LVEF>45%)、病因、合并症、诊断方法、治疗以及发病率和死亡率的信息。在第一年,评估登记系统中698名患者的基线参数后,我们发现大多数患者(87.8%)患有射血分数降低的心力衰竭,39.8%的患者心力衰竭起源于缺血性。最常见的合并症是高血压,其次是糖尿病、肾功能不全和慢性阻塞性肺疾病。94.4%的患者接受了ACE抑制剂或ARB治疗,95.9%的患者接受了β受体阻滞剂治疗,73.9%的患者接受了盐皮质激素受体拮抗剂治疗。神经激素拮抗剂的平均剂量高于当前指南定义的目标剂量的一半。心脏再同步治疗的使用率为11.7%,植入式心脏复律除颤器的使用率为25.8%。到目前为止,登记系统中患者的药物治疗和器械治疗符合当前指南的建议。然而,这并不意味着我国心力衰竭的管理没有问题,而是意味着在专门从事心力衰竭护理的心脏病学部门,通过适当的心力衰竭治疗可以提供高质量的患者护理。《匈牙利医学周报》,2017年,158(3),94-100。

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