Barrios V, Escobar C, Ortiz Cortés C, Cosín Sales J, Pascual Figal D A, García-Moll Marimón X
Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España.
Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España.
Rev Clin Esp (Barc). 2020 Aug-Sep;220(6):339-349. doi: 10.1016/j.rce.2019.10.011. Epub 2020 Feb 26.
To determine the perception and management of heart failure with reduced ejection fraction (HFrEF) by clinical cardiologists and to establish a consensus with recommendations.
We employed the modified Delphi method among a panel of 150 experts who answered a questionnaire that included three blocks: definition and perception of patients with «stable» HFrEF (15 statements), management of patients with «stable» HFrEF (51 statements) and recommendations for optimising the management and follow-up (9 statements). The level of agreement was assessed with a Likert 9-point scale.
A consensus of agreement was reached on 49 statements, a consensus of disagreement was reached on 16, and 10 statements remained undetermined. There was consensus regarding the definition of «stable» HF (82%), that HFrEF had a silent nature that could increase the mortality risk for mildly symptomatic patients (96%) and that the drug treatment should be optimised, regardless of whether a patient with HFrEF remains stable in the same functional class (98.7%). In contrast, there was a consensus of disagreement regarding the notion that treatment with an angiotensin receptor-neprilysin inhibitor is justified only when the functional class worsens (90.7%).
Our current understanding of «stable» HF is insufficient, and the treatment needs to be optimised, even for apparently stable patients, to decrease the risk of disease progression.
确定临床心脏病专家对射血分数降低的心力衰竭（HFrEF）的认知和管理，并就相关建议达成共识。
我们在150名专家组成的小组中采用了改良德尔菲法，这些专家回答了一份包含三个部分的问卷：“稳定型”HFrEF患者的定义和认知（15条陈述）、“稳定型”HFrEF患者的管理（51条陈述）以及优化管理和随访的建议（9条陈述）。采用9点李克特量表评估一致程度。
49条陈述达成了一致共识，16条达成了不一致共识，10条陈述仍未确定。对于“稳定型”心力衰竭的定义（82%）、HFrEF具有隐匿性且可能增加轻度症状患者的死亡风险（96%）以及无论HFrEF患者在同一功能分级中是否保持稳定，药物治疗都应优化（98.7%）达成了共识。相比之下，对于仅在功能分级恶化时才使用血管紧张素受体脑啡肽酶抑制剂进行治疗这一观点存在不一致共识（90.7%）。
我们目前对“稳定型”心力衰竭的认识不足，即使对于明显稳定的患者，治疗也需要优化，以降低疾病进展风险。
