Muiesan Maria Lorenza, Paini Anna, Agabiti Rosei Claudia, Bertacchini Fabio, Stassaldi Deborah, Salvetti Massimo
Department of Clinical and Experimental Sciences, University of Brescia, c/o 2ª Medicina, Spedali Civili, 25100, Brescia, Italy.
Department of Medicine, ASST-Spedali Civili of Brescia, Brescia, Italy.
High Blood Press Cardiovasc Prev. 2017 Jun;24(2):107-114. doi: 10.1007/s40292-017-0194-3. Epub 2017 Mar 27.
Heart failure (HF) is a major problem of public health. More than 23 million patients worldwide are affected by heart failure. Despite incidence and prevalence of heart failure may vary according to real world or randomized trials database, advancing age is a major determinant of heart failure. Heart failure is also characterized by an elevated rate of morbidity and mortality and represents one of the leading causes of hospitalization. A major consequence of heart failure is the frequent hospital admissions and related costs. Guidelines have clearly indicated evidence-based treatments in patients with heart failure, and the adherence to these indications has translated in an improvement of patient's prognosis. Nevertheless, the use of recommended treatments at the recommended dosages is still lower than expected. In the last year in Europe new guidelines on the diagnosis and treatment of heart failure and in USA an update on pharmacological treatment of heart failure were published, pointing the attention on the use of new available pharmacological and non-pharmacological treatments. HF syndrome reflects the interaction between hemodynamic dysregulation (alterations in myocardial preload, afterload, and contractility and a neurohormonal disarray those results in the development of symptoms and in the progression of the disease. Current treatment approaches target both hemodynamic alterations and the neurohumoral elements to slow disease progression as well as to improve symptoms and outcomes.
心力衰竭(HF)是一个重大的公共卫生问题。全球有超过2300万患者受到心力衰竭的影响。尽管心力衰竭的发病率和患病率可能因真实世界或随机试验数据库而异,但年龄增长是心力衰竭的主要决定因素。心力衰竭还具有发病率和死亡率升高的特点,是住院的主要原因之一。心力衰竭的一个主要后果是频繁住院及相关费用。指南已明确指出心力衰竭患者的循证治疗方法,遵循这些指征已使患者的预后得到改善。然而,按推荐剂量使用推荐治疗方法的比例仍低于预期。去年欧洲发布了关于心力衰竭诊断和治疗的新指南,美国发布了心力衰竭药物治疗的更新内容,将注意力集中在新型可用药物和非药物治疗方法的使用上。心力衰竭综合征反映了血流动力学失调(心肌前负荷、后负荷和收缩力的改变)与神经激素紊乱之间的相互作用,这些导致了症状的出现和疾病的进展。当前的治疗方法针对血流动力学改变和神经体液因素,以减缓疾病进展并改善症状和预后。