Stewart Simon
Hatter Institute, University of Cape Town, Cape Town, 8001, South Africa.
Curr Heart Fail Rep. 2019 Jun;16(3):75-80. doi: 10.1007/s11897-019-00426-1.
To determine the current evidence supporting the otherwise proven heart failure management programs (HFMPs) in the setting of an increasingly older and more complex patient population.
Attempts to replace proven face-to-face, multidisciplinary management of HF with remote management techniques (including telemedicine and implantable remote monitoring devices) have yielded mixed results. This may well reflect the clinical cascade effect of greater surveillance paradoxically leading to worse health outcomes as well as a narrow focus on HF alone in patients with clinically significant multimorbidity. Concurrently, there is preliminary evidence that the increasing phenomenon of HF and multimorbidity in older patients is undermining the otherwise positive impact of "traditional" HFMPs. A more nuanced approach to determining who would benefit from what form of HF management, including the integration of remote surveillance techniques, is required.
在患者日益老龄化且病情日益复杂的背景下，确定目前支持已获验证的心力衰竭管理项目（HFMPs）的证据。
尝试用远程管理技术（包括远程医疗和植入式远程监测设备）取代已获验证的面对面多学科心力衰竭管理，结果喜忧参半。这很可能反映出临床级联效应，即加强监测反而导致更差的健康结果，以及在患有具有临床意义的多种合并症的患者中仅将重点狭隘地放在心力衰竭上。同时，有初步证据表明，老年患者中日益增多的心力衰竭和多种合并症现象正在削弱“传统 ”HFMPs原本的积极影响。需要一种更细致入微的方法来确定谁将从何种形式的心力衰竭管理中获益，包括整合远程监测技术。
