Faculty of Medicine, Department of Medicine, Kuwait University, Kuwait.
Department of Medicine, Mubarak Al-Kabeer Hospital, Kuwait.
Angiology. 2020 May;71(5):431-437. doi: 10.1177/0003319720905742. Epub 2020 Feb 18.
We describe the characteristics of ambulatory patients with heart failure with reduced ejection fraction (HFrEF) in the Gulf region (Middle East) and the implementation of guideline-recommended treatments. We included 2427 HFrEF outpatients (mean age 59 ± 13 years, 75% males and median left ventricular ejection fraction [LVEF] of 30%). A high proportion of patients received guideline-recommended medications (angiotensin-converting enzyme inhibitor [ACEI]/angiotensin receptor blocker [ARB]/angiotensin receptor-neprilysin inhibitor [ARNI] 87%, β-blocker 91%, mineralocorticoid antagonist [MRA] 64%). However, only a minority of patients received guideline-recommended target doses (ACEI/ARB/ARNI 13%, β-blocker 27%, and MRA 4.4%). Old age was a significant independent predictor for not prescribing treatment ( < .001 for ACEI/ARB/ARNI and MRA; and = .002 for β-blockers). Other independent predictors were chronic kidney disease (for both ACEI/ARB/ARNI and MRA, < .001) and higher LVEF ( = .014 for β-blockers and < .001 for MRA). Patients with HFrEF managed by heart failure specialists more often received recommended target doses of ACEI/ARB/ARNI (40% vs 11%, < .001) and β-blockers (56% vs 26%, < .001) compared to those treated by general cardiologists. Although the majority of our patients with HFrEF received guideline-recommended medications, the doses they were prescribed were suboptimal. Understanding the reasons behind this is important for improved practice.
我们描述了海湾地区（中东）射血分数降低的心力衰竭（HFrEF）门诊患者的特征以及指南推荐治疗的实施情况。我们纳入了 2427 例 HFrEF 门诊患者（平均年龄 59 ± 13 岁，75%为男性，中位左心室射血分数[LVEF]为 30%）。很大比例的患者接受了指南推荐的药物治疗（血管紧张素转换酶抑制剂[ACEI]/血管紧张素受体阻滞剂[ARB]/血管紧张素受体脑啡肽酶抑制剂[ARNI]87%，β受体阻滞剂 91%，盐皮质激素受体拮抗剂[MRA]64%）。然而，只有少数患者接受了指南推荐的目标剂量（ACEI/ARB/ARNI 13%，β受体阻滞剂 27%，MRA 4.4%）。年龄较大是未开具治疗药物的显著独立预测因素（ACEI/ARB/ARNI 和 MRA 均 <.001；β受体阻滞剂为 =.002）。其他独立预测因素包括慢性肾脏病（ACEI/ARB/ARNI 和 MRA 均 <.001）和较高的 LVEF（β受体阻滞剂为 =.014，MRA 为 <.001）。由心力衰竭专家管理的 HFrEF 患者更常接受 ACEI/ARB/ARNI（40%比 11%， <.001）和β受体阻滞剂（56%比 26%， <.001）的推荐目标剂量。尽管我们的大多数 HFrEF 患者接受了指南推荐的药物治疗，但他们的处方剂量并不理想。了解这背后的原因对于改善实践非常重要。
