Department of Medicine, University of Mississippi, Jackson, Mississippi.
Merck & Co., Inc., Kenilworth, New Jersey.
J Am Coll Cardiol. 2019 Mar 5;73(8):935-944. doi: 10.1016/j.jacc.2018.11.049.
Epidemiology of patients with worsening heart failure and reduced ejection fraction (HFrEF) in the real-world setting is not well described.
The purpose of this study was to describe incidence, clinical characteristics, treatment, and outcomes of patients with HFrEF who develop worsening heart failure (HF) in the real-world setting.
Data on patients with incident HFrEF from the National Cardiovascular Data Registry PINNACLE were linked to pharmacy, private practitioner, and hospital claims databases. Incidence, clinical characteristics, treatment (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker, and mineralocorticoid receptor antagonist) and outcomes of patients with worsening HF, defined as ≥90 days of stable HF with subsequent worsening requiring intravenous diuretic agents, were assessed.
Of 11,064 HFrEF patients, 1,851 (17%) developed worsening HF on average 1.5 years following initial HF diagnosis. Patients who developed worsening HF were more likely to be African American, be octogenarians, and have higher comorbidity burden (p < 0.001). At the onset of worsening HF, 42.4% of patients were on monotherapy, 43.4% were on dual therapy, and 14.1% were on triple therapy. A total of 48%, 61%, and 98% of patients were on >50% target dose for angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker, and mineralocorticoid receptor antagonist, respectively. The 2-year mortality rate was 22.5%, and 56% of patients were rehospitalized within 30 days of the worsening HF event.
In the real-world setting, 1 in 6 patients with HFrEF develop worsening HF within 18 months of HF diagnosis. These patients have a high risk for 2-year mortality and recurrent HF hospitalizations. The use of standard-of-care therapies both before and after the onset of worsening HF is low. With high unmet medical need, patients with worsening HF require novel treatment strategies as well as greater optimization of existing guideline-directed therapy.
在真实环境中，射血分数降低的心力衰竭（HFrEF）患者病情恶化的流行病学情况尚不清楚。
本研究旨在描述真实环境中发生心力衰竭恶化（HF）的 HFrEF 患者的发病情况、临床特征、治疗方法和结局。
利用国家心血管数据登记处 PINNACLE 中的 HFrEF 患者数据，与药房、私人医生和医院索赔数据库进行关联。评估心力衰竭恶化患者的发生率、临床特征、治疗方法（血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂、β受体阻滞剂和盐皮质激素受体拮抗剂）和结局，心力衰竭恶化定义为：初始 HF 诊断后至少 90 天稳定 HF 后病情恶化，需要静脉使用利尿剂。
在 11064 例 HFrEF 患者中，1851 例（17%）患者平均在 HF 诊断后 1.5 年出现心力衰竭恶化。发生心力衰竭恶化的患者更可能为非裔美国人、为 80 岁以上老年人，且合并症负担更重（p<0.001）。在心力衰竭恶化发生时，42.4%的患者接受单药治疗，43.4%的患者接受双联治疗，14.1%的患者接受三联治疗。血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂、β受体阻滞剂和盐皮质激素受体拮抗剂的目标剂量分别有 48%、61%和 98%的患者使用剂量>50%。2 年死亡率为 22.5%，56%的患者在心力衰竭恶化事件后 30 天内再次住院。
在真实环境中，HFrEF 患者中有 1/6 在 HF 诊断后 18 个月内发生心力衰竭恶化。这些患者有发生 2 年死亡率和 HF 再住院的高风险。在心力衰竭恶化发生前后，标准治疗的使用率均较低。鉴于存在高度未满足的医疗需求，心力衰竭恶化患者需要新的治疗策略以及对现有指南指导治疗的进一步优化。
