Morbach Caroline, Wagner Martin, Güntner Stefan, Malsch Carolin, Oezkur Mehmet, Wood David, Kotseva Kornelia, Leyh Rainer, Ertl Georg, Karmann Wolfgang, Heuschmann Peter U, Störk Stefan
Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.
Department of Medicine I, University Hospital of Würzburg, Wuerzburg, Germany.
BMC Cardiovasc Disord. 2017 May 5;17(1):108. doi: 10.1186/s12872-017-0543-0.
Adherence to pharmacotherapeutic treatment guidelines in patients with heart failure (HF) is of major prognostic importance, but thorough implementation of guidelines in routine care remains insufficient. Our aim was to investigate prevalence and characteristics of HF in patients with coronary heart disease (CHD), and to assess the adherence to current HF guidelines in patients with HF stage C, thus identifying potential targets for the optimization of guideline implementation.
Patients from the German sample of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EuroAspire) IV survey with a hospitalization for CHD within the previous six to 36 months providing valid data on echocardiography as well as on signs and symptoms of HF were categorized into stages of HF: A, prevalence of risk factors for developing HF; B, asymptomatic but with structural heart disease; C, symptomatic HF. A Guideline Adherence Indicator (GAI-3) was calculated for patients with reduced (≤40%) left ventricular ejection fraction (HFrEF) as number of drugs taken per number of drugs indicated; beta-blockers, angiotensin converting enzyme inhibitors/angiotensin receptor blockers, and mineralocorticoid receptor antagonists (MRA) were considered.
509/536 patients entered analysis. HF stage A was prevalent in n = 20 (3.9%), stage B in n = 264 (51.9%), and stage C in n = 225 (44.2%) patients; 94/225 patients were diagnosed with HFrEF (42%). Stage C patients were older, had a longer duration of CHD, and a higher prevalence of arterial hypertension. Awareness of pre-diagnosed HF was low (19%). Overall GAI-3 of HFrEF patients was 96.4% with a trend towards lower GAI-3 in patients with lower LVEF due to less thorough MRA prescription.
In our sample of CHD patients, prevalence of HF stage C was high and a sizable subgroup suffered from HFrEF. Overall, pharmacotherapy was fairly well implemented in HFrEF patients, although somewhat worse in patients with more reduced ejection fraction. Two major targets were identified possibly suited to further improve the implementation of HF guidelines: 1) increase patients´ awareness of diagnosis and importance of HF; and 2) disseminate knowledge about the importance of appropriately implementing the use of mineralocorticoid receptor antagonists.
This is a cross-sectional analysis of a non-interventional study. Therefore, it was not registered as an interventional trial.
心力衰竭（HF）患者对药物治疗指南的依从性具有重要的预后意义，但在常规护理中全面实施指南仍显不足。我们的目的是调查冠心病（CHD）患者中HF的患病率和特征，并评估C期HF患者对当前HF指南的依从性，从而确定优化指南实施的潜在目标。
来自欧洲通过干预减少事件进行二级和一级预防行动（EuroAspire）IV调查德国样本的患者，在过去6至36个月内因CHD住院，提供了关于超声心动图以及HF体征和症状的有效数据，这些患者被分为HF阶段：A，发生HF的危险因素患病率；B，无症状但有结构性心脏病；C，有症状的HF。对于左心室射血分数降低（≤40%）（HFrEF）的患者，计算指南依从性指标（GAI-3），即服用药物数量与指示药物数量之比；考虑使用β受体阻滞剂、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂和盐皮质激素受体拮抗剂（MRA）。
509/536例患者进入分析。HF A期在n = 20例（3.9%）患者中普遍存在，B期在n = 264例（51.9%）患者中普遍存在，C期在n = 225例（44.2%）患者中普遍存在；94/225例患者被诊断为HFrEF（42%）。C期患者年龄更大，CHD病程更长，动脉高血压患病率更高。对预先诊断的HF的知晓率较低（19%）。HFrEF患者的总体GAI-3为96.4%，由于MRA处方不够全面，LVEF较低的患者GAI-3有降低趋势。
在我们的CHD患者样本中，C期HF的患病率较高，相当一部分亚组患有HFrEF。总体而言，HFrEF患者的药物治疗实施得相当好，尽管射血分数降低更多的患者情况稍差。确定了两个可能适合进一步改善HF指南实施的主要目标：1）提高患者对HF诊断及其重要性的认识；2）传播关于适当使用盐皮质激素受体拮抗剂重要性的知识。
这是一项非干预性研究的横断面分析。因此，它未作为干预性试验进行注册。
