Department of Clinical Pharmacy, Saxenburgh Group, P.O. Box 1, 7770 AA, Hardenberg, the Netherlands.
Department of Clinical Pharmacy, Hospital Group Twente, Almelo and Hengelo, the Netherlands.
Heart Fail Rev. 2019 Jul;24(4):499-510. doi: 10.1007/s10741-019-09777-2.
Prescriber adherence to guideline-recommended medication in patients with heart failure (HF) in clinical practice is suboptimal. We analyzed how evolving guideline recommendations influenced medication profiles after a first HF hospitalization. We extracted medication profiles from the Dutch PHARMO Database Network for 22,476 patients with a diagnosis of HF at hospital discharge between 2001 and 2015. The percentage of patients prescribed the combination of a beta-blocker (BB) and an angiotensin-converting-enzyme inhibitor (ACEI) or angiotensin-receptor blocker (ARB) increased from 24 to approximately 45% within this 15-year period. The percentage of patients who also used a mineralocorticoid-receptor antagonist (MRA) reached approximately 20%. The probability of being prescribed these combinations decreased with increasing age. As a consequence of the policy change in the ESC guideline 2001, the use of BB increased from less than 40% in 2001 to about 70% by 2015. The percentage of patients prescribed an ACEI and/or an ARB, an MRA, or a diuretic was about stable, at respectively 63%, 37%, and 82%. Although the 2012 ESC guideline also advised MRA in the New York Heart Association (NYHA) class II, there was no increase in MRA prescriptions. Compliance with the ESC guidelines varied for the individual recommendations. Remarkably, there was no significant increase in MRA prescriptions. At the same time, developments were demonstrated, which were not instigated by the guidelines, like the shift from ACEI to ARB. Although the exact HF classification of our patients was unknown, given a relatively stable case mix, our data provide insight into "real-world" pharmacological management.
在临床实践中，医生遵循指南推荐的心力衰竭（HF）药物治疗并不理想。我们分析了不断变化的指南建议如何影响首次 HF 住院后的药物治疗方案。我们从荷兰 PHARMO 数据库网络中提取了 2001 年至 2015 年期间 22476 例出院时诊断为 HF 的患者的药物治疗方案。在这 15 年期间，同时开具β受体阻滞剂（BB）和血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）的患者比例从 24%增加到约 45%。同时开具盐皮质激素受体拮抗剂（MRA）的患者比例达到约 20%。这些组合药物的开具概率随年龄的增加而降低。由于 2001 年 ESC 指南的政策变化，BB 的使用量从 2001 年的不到 40%增加到 2015 年的约 70%。开具 ACEI 和/或 ARB、MRA 或利尿剂的患者比例分别约为 63%、37%和 82%，基本保持稳定。尽管 2012 年 ESC 指南也建议在纽约心脏协会（NYHA）II 级使用 MRA，但 MRA 的处方量并未增加。对个别建议的 ESC 指南的遵守情况各不相同。值得注意的是，MRA 的处方量并没有显著增加。同时，也出现了一些指南未提出的发展趋势，如 ACEI 向 ARB 的转变。尽管我们患者的确切 HF 分类未知，但鉴于相对稳定的病例组合，我们的数据提供了对“真实世界”药物治疗的了解。
