Cowie Martin R, Anker Stefan D, Cleland John G F, Felker G Michael, Filippatos Gerasimos, Jaarsma Tiny, Jourdain Patrick, Knight Eve, Massie Barry, Ponikowski Piotr, López-Sendón José
National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, UK.
Charité-University Medical Centre, Campus Virchow-Klinikum, Berlin, Germany.
ESC Heart Fail. 2014 Dec;1(2):110-145. doi: 10.1002/ehf2.12021. Epub 2015 Jan 21.
Acute heart failure (AHF) is a common and serious condition that contributes to about 5% of all emergency hospital admissions in Europe and the USA. Here, we present the recommendations from structured discussions among an author group of AHF experts in 2013. The epidemiology of AHF and current practices in diagnosis, treatment, and long-term care for patients with AHF in Europe and the USA are examined. Available evidence indicates variation in the quality of care across hospitals and regions. Challenges include the need for rapid diagnosis and treatment, the heterogeneity of precipitating factors, and the typical repeated episodes of decompensation requiring admission to hospital for stabilization. In hospital, care should involve input from an expert in AHF and auditing to ensure that guidelines and protocols for treatment are implemented for all patients. A smooth transition to follow-up care is vital. Patient education programmes could have a dramatic effect on improving outcomes. Information technology should allow, where appropriate, patient telemonitoring and sharing of medical records. Where needed, access to end-of-life care and support for all patients, families, and caregivers should form part of a high-quality service. Eight evidence-based consensus policy recommendations are identified by the author group: optimize patient care transitions, improve patient education and support, provide equity of care for all patients, appoint experts to lead AHF care across disciplines, stimulate research into new therapies, develop and implement better measures of care quality, improve end-of-life care, and promote heart failure prevention.
急性心力衰竭（AHF）是一种常见且严重的病症，在欧洲和美国约占急诊住院病例的5%。在此，我们呈现2013年AHF专家作者小组进行结构化讨论后得出的建议。对欧美地区AHF的流行病学以及AHF患者的诊断、治疗和长期护理的当前实践进行了研究。现有证据表明，不同医院和地区的医疗质量存在差异。挑战包括需要快速诊断和治疗、诱发因素的异质性，以及典型的反复失代偿发作需要住院以实现病情稳定。在医院，护理工作应包括AHF专家的参与以及审核，以确保为所有患者实施治疗指南和方案。顺利过渡到后续护理至关重要。患者教育计划可能对改善治疗结果产生显著影响。信息技术应在适当情况下实现患者远程监测和病历共享。在需要时，为所有患者、家属和护理人员提供临终关怀和支持应成为高质量服务的一部分。作者小组确定了八项基于证据的共识政策建议：优化患者护理过渡、改善患者教育和支持、为所有患者提供公平护理、指定专家跨学科引领AHF护理、推动新疗法研究、制定并实施更好的护理质量衡量标准、改善临终关怀以及促进心力衰竭预防。
