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台湾心脏病学会心力衰竭诊断与治疗指南2019重点更新版

2019 Focused Update of the Guidelines of the Taiwan Society of Cardiology for the Diagnosis and Treatment of Heart Failure.

作者信息

Wang Chun-Chieh, Wu Cho-Kai, Tsai Ming-Lung, Lee Chii-Ming, Huang Wei-Chun, Chou Hsin-Hua, Huang Jin-Long, Chi Nai-Hsin, Yen Hsueh-Wei, Tzeng Bing-Hsiean, Chang Wei-Ting, Chang Hung-Yu, Wang Chao-Hung, Lu Yen-Yu, Tsai Jui-Peng, Su Chun-Hung, Cherng Wen-Jin, Yin Wei-Hsian, Tsai Chia-Ti, Wu Yen-Wen, Lin Jiunn-Lee, Hwang Juey-Jen

机构信息

Division of Cardiology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan.

Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei.

出版信息

Acta Cardiol Sin. 2019 May;35(3):244-283. doi: 10.6515/ACS.201905_35(3).20190422A.

Abstract

Heart failure is a growing epidemic, especially in Taiwan because of the aging population. The 2016 Taiwan Society of Cardiology - Heart Failure with reduced Ejection Fraction (TSOC-HFrEF) registry showed that the guideline-recommended therapies were prescribed suboptimally both at the time of hospital discharge and during follow-up. We, therefore, conducted this 2019 focused update of the guidelines of the Taiwan Society of Cardiology for the diagnosis and treatment of heart failure to reinforce the importance of new diagnostic and therapeutic modalities of heart failure. The 2019 focused update discusses new diagnostic criteria, pharmacotherapy, non-pharmacological management, and certain co-morbidities of heart failure. Angiotensin receptor neprilysin inhibitor and If channel inhibitor is introduced as new and recommended medical therapies. Latest criteria of cardiac resynchronization therapy, implantable cardioverter-defibrillator, heart transplantation, and ventricular assist device therapy are reviewed in the non-pharmacological management chapter. Co-morbidities in heart failure are discussed including chronic kidney disease, diabetes, chronic obstructive pulmonary disease, and sleep-disordered breathing. We also explain the adequate use of oxygen therapy and non-invasive ventilation in heart failure management. A particular chapter for chemotherapy-induced cardiac toxicity is incorporated in the focused update to emphasize the importance of its recognition and management. Lastly, implications from the TSOC-HFrEF registry and post-acute care of heart failure are discussed to highlight the importance of guideline-directed medical therapy and the benefits of multidisciplinary disease management programs. With guideline recommendations, we hope that the management of heart failure can be improved in our society.

摘要

心力衰竭是一种日益严重的流行病,在台湾尤其如此,因为人口老龄化。2016年台湾心脏病学会-射血分数降低的心力衰竭(TSOC-HFrEF)登记研究表明,在出院时和随访期间,指南推荐的治疗方法使用得并不理想。因此,我们对台湾心脏病学会心力衰竭诊断和治疗指南进行了2019年重点更新,以强化心力衰竭新诊断和治疗方式的重要性。2019年重点更新讨论了新的诊断标准、药物治疗、非药物管理以及心力衰竭的某些合并症。血管紧张素受体脑啡肽酶抑制剂和If通道抑制剂作为新的推荐药物治疗方法被引入。非药物管理章节回顾了心脏再同步治疗、植入式心脏复律除颤器、心脏移植和心室辅助装置治疗的最新标准。讨论了心力衰竭的合并症,包括慢性肾脏病、糖尿病、慢性阻塞性肺疾病和睡眠呼吸障碍。我们还解释了在心力衰竭管理中氧疗和无创通气的合理使用。重点更新中纳入了一个关于化疗引起的心脏毒性的特别章节,以强调其识别和管理的重要性。最后,讨论了TSOC-HFrEF登记研究的意义以及心力衰竭的急性后期护理,以突出指南指导的药物治疗的重要性和多学科疾病管理项目的益处。通过指南推荐,我们希望能改善我们社会中对心力衰竭的管理。

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