Department of Cardiology, Başkent University Istanbul Hospital, Istanbul, Turkey.
Department of Cardiology, Firat University, School of Medicine Hospital, Elazığ, Turkey.
Anatol J Cardiol. 2020 Jul;24(1):32-40. doi: 10.14744/AnatolJCardiol.2020.91771.
Despite recommendations from heart failure guidelines on the use of pharmacologic and device therapy in patients with heart failure with reduced ejection fraction (HFrEF), important inconsistencies in guideline adherence persist in practice. The aim of this study was to assess adherence to guideline-directed medical and device therapy for the treatment of patients with chronic HFrEF (left ventricular ejection fraction ≤40%).
The Adherence to guideline-directed medical and device Therapy in outpAtients with HFrEF (ATA) study is a prospective, multicenter, observational study conducted in 24 centers from January 2019 to June 2019.
The study included 1462 outpatients (male: 70.1%, mean age: 67±11 years, mean LVEF: 30%±6%) with chronic HFrEF. Renin-angiotensin system (RAS) inhibitors, beta-blockers, mineralocorticoid receptor antagonists (MRAs), and ivabradin were used in 78.2%, 90.2%, 55.4%, and 12.1% of patients, respectively. The proportion of patients receiving target doses of medical treatments was 24.6% for RAS inhibitors, 9.9% for beta-blockers, and 10.5% for MRAs. Among patients who met the criteria for implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT), only 16.9% of patients received an ICD (167 of 983) and 34% (95 of 279) of patients underwent CRT (95 of 279).
The ATA study shows that most HFrEF outpatients receive RAS inhibitors and beta-blockers but not MRAs or ivabradin when the medical reasons for nonuse, such as drug intolerance or contraindications, are taken into account. In addition, most eligible patients with HFrEF do not receive target doses of pharmacological treatments or guideline-recommended device therapy.
尽管心力衰竭指南推荐在射血分数降低的心力衰竭（HFrEF）患者中使用药物和器械治疗，但在实践中，指南遵循情况仍存在重要差异。本研究旨在评估慢性 HFrEF（左心室射血分数≤40%）患者接受指南指导的药物和器械治疗的依从性。
Adherence to guideline-directed medical and device Therapy in outpAtients with HFrEF（ATA）研究是一项前瞻性、多中心、观察性研究，于 2019 年 1 月至 6 月在 24 个中心进行。
该研究纳入了 1462 例慢性 HFrEF 门诊患者（男性：70.1%，平均年龄：67±11 岁，平均 LVEF：30%±6%）。血管紧张素转换酶抑制剂（ACEI）/血管紧张素受体拮抗剂（ARB）、β受体阻滞剂、盐皮质激素受体拮抗剂（MRA）和伊伐布雷定的使用率分别为 78.2%、90.2%、55.4%和 12.1%。接受药物治疗目标剂量的患者比例分别为 ACEI/ARB 24.6%、β受体阻滞剂 9.9%和 MRA 10.5%。在符合植入式心脏复律除颤器（ICD）和心脏再同步治疗（CRT）标准的患者中，仅 16.9%（167/983）的患者接受了 ICD，34%（95/279）的患者接受了 CRT（95/279）。
ATA 研究表明，大多数 HFrEF 门诊患者接受 ACEI/ARB 和β受体阻滞剂治疗，但在考虑药物不耐受或禁忌等非用药原因时，不使用 MRA 或伊伐布雷定。此外，大多数符合条件的 HFrEF 患者未接受药物治疗的目标剂量或指南推荐的器械治疗。
