Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut National de la Santé et de la Recherche Médicale (Inserm), Centre Hospitalier Régional Universitaire (CHRU) de Nancy, Inserm U1116, and French Clinical Research Network, Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (FCRIN INI-CRCT), Nancy, France.
Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina, NC, USA.
Lancet. 2019 Mar 9;393(10175):1034-1044. doi: 10.1016/S0140-6736(18)31808-7.
Heart failure is the most common cardiovascular reason for hospital admission for people older than 60 years of age. Few areas in medicine have progressed as remarkably as heart failure treatment over the past three decades. However, progress has been consistent only for chronic heart failure with reduced ejection fraction. In acutely decompensated heart failure and heart failure with preserved ejection fraction, none of the treatments tested to date have been definitively proven to improve survival. Delaying or preventing heart failure has become increasingly important in patients who are prone to heart failure. The prevention of worsening chronic heart failure and hospitalisations for acute decompensation is also of great importance. The objective of this Series paper is to provide a concise and practical summary of the available drug treatments for heart failure. We support the implementation of the international guidelines. We offer views on the basis of our personal experience in research areas that have insufficient evidence. The best possible evidence-based drug treatment (including inhibitors of the renin-angiotensin-aldosterone system and β blockers) is useful only when optimally implemented. However, implementation might be challenging. We believe that disease management programmes can be helpful in providing a multidisciplinary, holistic approach to the delivery of optimal medical care.
心力衰竭是 60 岁以上人群因心血管疾病住院的最常见原因。在过去的三十年中，医学领域几乎没有哪个领域像心力衰竭治疗那样取得了如此显著的进展。然而，这种进展仅在射血分数降低的慢性心力衰竭方面得到了持续证实。在急性失代偿性心力衰竭和射血分数保留性心力衰竭中，迄今为止，尚无任何已测试的治疗方法被明确证明可以改善生存。对于易患心力衰竭的患者，延迟或预防心力衰竭变得越来越重要。预防慢性心力衰竭恶化和急性失代偿住院治疗也非常重要。本系列论文的目的是提供一份简明实用的心力衰竭现有药物治疗概述。我们支持国际指南的实施。我们根据个人在证据不足的研究领域的经验提出观点。只有在最佳实施的情况下，尽可能最好的循证药物治疗（包括肾素-血管紧张素-醛固酮系统抑制剂和β受体阻滞剂）才有用。然而，实施可能具有挑战性。我们认为，疾病管理计划有助于提供多学科、整体的方法来提供最佳的医疗护理。
