Chioncel Ovidiu, Collins Sean P, Greene Stephen J, Pang Peter S, Ambrosy Andrew P, Antohi Elena-Laura, Vaduganathan Muthiah, Butler Javed, Gheorghiade Mihai
Carol Davila University of Medicine and Pharmacy, Emergency Institute for Cardiovascular Diseases,Bucharest, Romania.
Vanderbilt University Medical Center,Nashville,TN, USA.
Card Fail Rev. 2017 Nov;3(2):122-129. doi: 10.15420/cfr.2017:12:1.
Acute Heart Failure (AHF) is a " multi-event disease" and hospitalisation is a critical event in the clinical course of HF. Despite relatively rapid relief of symptoms, hospitalisation for AHF is followed by an increased risk of death and re-hospitalisation. In AHF, risk stratification from clinically available data is increasingly important in evaluating long-term prognosis. From the perspective of patients, information on the risk of mortality and re-hospitalisation would be helpful in providing patients with insight into their disease. From the perspective of care providers, it may facilitate management decisions, such as who needs to be admitted and to what level of care (i.e. floor, step-down, ICU). Furthermore, risk-stratification may help identify patients who need to be evaluated for advanced HF therapies (i.e. left-ventricle assistance device or transplant or palliative care), and patients who need early a post-discharge follow-up plan. Finally, risk stratification will allow for more robust efforts to identify among risk markers the true targets for therapies that may direct treatment strategies to selected high-risk patients. Further clinical research will be needed to evaluate if appropriate risk stratification of patients could improve clinical outcome and resources allocation.
急性心力衰竭(AHF)是一种“多事件疾病”,住院是心力衰竭临床过程中的一个关键事件。尽管症状相对较快得到缓解,但AHF患者住院后死亡和再次住院的风险会增加。在AHF中,根据临床可用数据进行风险分层对于评估长期预后越来越重要。从患者的角度来看,关于死亡和再次住院风险的信息有助于患者深入了解自己的病情。从医护人员的角度来看,它可能有助于做出管理决策,比如哪些患者需要住院以及接受何种护理级别(即普通病房、过渡病房、重症监护病房)。此外,风险分层可能有助于识别那些需要接受晚期心力衰竭治疗评估的患者(即左心室辅助装置、移植或姑息治疗),以及那些需要早期出院后随访计划的患者。最后,风险分层将有助于更有力地在风险标志物中识别出真正的治疗靶点,从而可能将治疗策略导向选定的高危患者。还需要进一步的临床研究来评估对患者进行适当的风险分层是否能够改善临床结局和资源分配。