Mureddu Gian Francesco, Nistri Stefano, Gori Anna Maria, Faggiano Pompilio, Fimiani Biagio, Maggi Antonio, Misuraca Gianfranco, Uguccioni Massimo, Tavazzi Luigi, Zito Giovanni Battista
San Giovanni-Addolorata Hospital, Cardiac Rehabilitation Unit, Rome.
Monaldi Arch Chest Dis. 2019 Mar 20;89(1). doi: 10.4081/monaldi.2019.1006.
A key factor in cardiovascular prevention is the detection and appropriate management of preclinical heart failure (HF), but information on the subject is scarce. We designed VASTISSIMO as a prospective, observational study to investigate Outpatient Clinic Cardiologists' skills in detecting and managing preclinical HF in Italy. Quality scores were used to assess the appropriateness of clinical management according to guideline recommendations. The feasibility of making a diagnosis of preclinical HF in a cardiology outpatient clinical setting, cardiologists' awareness of preclinical HF and consistency between physician's perceived risk of HF and the patient's classification into the preclinical HF Stages A [(SAHF) or B (SBHF)] have been investigated. Consistency was defined acceptable if the concordance between perceived risk and actual risk was >70%. Out of 3322 patients included in the study data necessary for identifying SBHF were collected in 2106 (63.4%). Many SBHF patients had their risk underestimated: 16.2% of those with previous acute myocardial infarction (AMI), 23.1% with left ventricular hypertrophy (LVH) at ECG/echocardiography, 30% with systolic/diastolic dysfunction, and 14.3% with valve disease. Cardiologists' awareness of preclinical HF in the outpatient setting should be improved. This is a critical area of cardiovascular prevention that requires attention to improve good clinical practice and adherence to guidelines.
心血管疾病预防的一个关键因素是对临床前心力衰竭（HF）的检测和适当管理，但关于这一主题的信息很少。我们设计了VASTISSIMO作为一项前瞻性观察性研究，以调查意大利门诊心脏病专家在检测和管理临床前HF方面的技能。根据指南建议，使用质量评分来评估临床管理的适宜性。我们研究了在心脏病门诊临床环境中诊断临床前HF的可行性、心脏病专家对临床前HF的认知以及医生感知的HF风险与患者临床前HF分期A [（SAHF）或B（SBHF）]分类之间的一致性。如果感知风险与实际风险之间的一致性>70%，则定义为一致性可接受。在纳入研究的3322例患者中，收集到识别SBHF所需数据的有2106例（63.4%）。许多SBHF患者的风险被低估：既往有急性心肌梗死（AMI）的患者中有16.2%、心电图/超声心动图显示有左心室肥厚（LVH）的患者中有23.1%、有收缩期/舒张期功能障碍的患者中有30%以及有瓣膜病的患者中有14.3%。门诊环境中心脏病专家对临床前HF的认知应得到提高。这是心血管疾病预防的一个关键领域，需要加以关注以改善良好的临床实践并遵守指南。
